Research Article| Volume 56, ISSUE 11, P2113-2117, November 2021

Surgical outcomes and psychosocial impact of giant congenital melanocytic nevus surgery: A single-center case series of 136 patients


      • Surgery is a safe treatment for GCMN.
      • Expanded skin flaps are the most optimal surgical option in most cases.
      • Surgeons, patients, and caregivers agree that surgical treatment should begin in the first months of life.
      • Surgical treatment has a low impact on QoL.


      Purpose: The aim of this study was to evaluate the outcomes, complications and psychosocial impact of surgical treatment of giant congenital melanocytic nevus (GCMN).
      Methods: Patients with surgically treated GCMN who attended our clinic between May 2014 and May 2018 were included. Patient demographics and data on the characteristics of the nevus, surgical treatment, and the psychosocial impact (including C-DLQI/DLQI questionnaires) were collected.
      Results: One hundred thirty-six patients were included (median age 9 years). Mean age at first surgery was 34 (+/- 61.45) months; 5.53 (+/- 3.69) surgical interventions were necessary to completely excise the nevus. The expanded skin flap was the preferred surgical technique in most locations. Complications were common but not severe. Of the patients studied, 70.4% reported that the surgery had a minor impact on their quality of life (QoL). Patients and caregivers stated that surgical treatment should begin as soon as possible, even in cases where early treatment did not have an impact on their QoL nor on their satisfaction with the surgery (p < 0.05). The lower the patient age at first surgery, the higher the surgeon's satisfaction (p < 0.01).
      Conclusions: Surgical treatment is a safe option for management of GCMN, and has a low impact on QoL. Patients, caregivers, and surgeons agree that the treatment should begin as soon as possible. This is the largest single-center study evaluating surgical treatment in GCMN patients and its psychosocial impact, and the first to take into account the patient, caregivers and dermatologists opinion of surgical results.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ruiz-Maldonado R.
        Measuring congenital melanocytic nevi.
        Pediatr Dermatol. 2004; 21: 178-179
        • Krengel S.
        • Scope A.
        • Dusza S.W.
        • Vonthein R.
        • Marghoob A.A.
        New recommendations for the categorization of cutaneous features of congenital melanocytic nevi.
        J Am Acad Dermatol. 2013; 68: 441-451
        • Castilla E.E.
        • da Graça Dutra M.
        • Orioli-Parreiras I.M.
        Epidemiology of congenital pigmented naevi: I. Incidence rates and relative frequencies.
        Br J Dermatol. 1981; 104: 307-315
        • Watt A.J.
        • Kotsis S.V.
        • Chung K.C.
        Risk of melanoma arising in large congenital melanocytic nevi: a systematic review.
        Plast Reconstr Surg. 2004; 113: 1968-1974
        • Krengel S.
        • Hauschild A.
        • Schäfer T.
        Melanoma risk in congenital melanocytic naevi: a systematic review.
        Br J Dermatol. 2006; 155: 1-8
        • Kinsler V.A.
        • O'Hare P.
        • Bulstrode N.
        • Calonje J.E.
        • Chong W.K.
        • Hargrave D.
        • et al.
        Melanoma risk in congenital melanocytic naevi.
        Br J Dermatol. 2017; 176: 1131-1143
        • Vourc'H-Jourdain M.
        • Martin L.
        • Barbarot S
        Large congenital melanocytic nevi: therapeutic management and melanoma risk: a systematic review.
        J Am Acad Dermatol. 2013; 68: 493-498
        • Wramp M.E.
        • Langenbruch A.
        • Augustin M.
        • Zillikens D.
        • Krengel S.
        Clinical course, treatment modalities, and quality of life in patients with congenital melanocytic nevi – data from the German CMN registry.
        J Der Dtsch Dermatologischen Gesellschaft. 2017; 15: 159-167
        • Bittencourt F.V.
        • Marghoob A.A.
        • Kopf A.W.
        • Koenig K.L.
        • Bart R.S.
        Large congenital melanocytic nevi and the risk for development of malignant melanoma and neurocutaneous melanocytosis.
        Pediatrics. 2000; 106: 736-741
        • Hale E.K.K.
        • Stein J.
        • Ben-Porat L.
        • Panageas K.S.S.
        • Eichenbaum M.S.S.
        • Marghoob A.A.A.
        • et al.
        Association of melanoma and neurocutaneous melanocytosis with large congenital melanocytic naevi — results from the NYU – LCMN registry.
        Br J Dermatol. 2005; 152: 512-517
        • Foster R.D.
        • Williams M.L.
        • Barkovich A.J.
        • Hoffman W.Y.
        • Mathes S.J.
        • Frieden I.J.
        • et al.
        Giant congenital melanocytic nevi: the significance of neurocutaneous melanosis in neurologically asymptomatic children.
        Plast Reconstr Surg. 2001; 107: 933-941
        • Agero A.L.C.
        • Benvenuto-Andrade C.
        • Dusza S.W.
        • Halpern A.C.
        • Marghoob A.A.
        Asymptomatic neurocutaneous melanocytosis in patients with large congenital melanocytic nevi: a study of cases from an internet-based registry.
        J Am Acad Dermatol. 2005; 53: 959-965
        • Arneja J.S.
        • Gosain A.K.
        Giant congenital melanocytic nevi.
        Plast Reconstr Surg. 2009; 124: 1-13
        • Tromberg J.
        • Bauer B.
        • Benvenuto-Andrade C.
        • Marghoob A.A.
        Congenital melanocytic nevi needing treatment.
        Dermatol Ther. 2005; 18: 136-150
        • Bauer B.S.
        • Few J.W.
        • Chavez C.D.
        • Galiano R
        The role of tissue expansion in the management of large congenital pigmented nevi of the forehead in the pediatric patient.
        Plast Reconstr Surg. 2001; 107: 668-675
        • Bauer B.S.
        • Margulis A.
        • Adler N.
        Congenital melanocytic nevi of the eyelids and periorbital region.
        Plast Reconstr Surg. 2009; 124: 1273-1283
        • Feins N.R.
        • Rubin R.
        • Borger J.A.
        Ambulatory serial excision of giant nevi.
        J Pediatr Surg. 1982; 17: 851-853
        • Fujiwara M.
        • Nakamura Y F.H
        Treatment of giant congenital nevus of the back by convergent serial excision.
        J Dermatol. 2008; 35: 608-610
        • Su J.J.
        • Chang D.K.
        • Mailey B.
        • Gosman A.
        Treatment of a giant congenital melanocytic nevus in the adult: review of the current management of giant congenital melanocytic nevus.
        Ann Plast Surg. 2015; 74: S57-S61
        • Zaal L.H.
        • Van Der Horst C.M
        Results of the early use of tissue expansion for giant congenital melanocytic naevi on the scalp and face.
        J Plast Reconstr Aesthetic Surg. 2009; 62: 216-220
        • Gonzalez Ruiz Y.
        • López Gutiérrez J.C
        Multiple tissue expansion for giant congenital melanocytic nevus.
        Ann Plast Surg. 2017; 79: e37-e40
        • Olsen J.R.
        • Gallacher J.
        • Finlay A.Y.
        • Piguet V.
        • Francis N.A.
        Quality of life impact of childhood skin conditions measured using the children's dermatology life quality index (CDLQI): a meta-analysis.
        Br J Dermatol. 2016; 174: 853-861
        • Berg P.
        • Lindelöf B.
        Congenital nevocytic nevi: follow-up of a Swedish Birth Register sample regarding etiologic factors, discomfort, and removal rate.
        Pediatr Dermatol. 2002; 19: 293-297
        • Kinsler V.A.
        • Birley J.
        • Atherton D.J.
        Great Ormond street hospital for children registry for congenital melanocytic naevi: prospective study 1988-2007. Part 2 - Evaluation of treatments.
        Br J Dermatol. 2009; 160: 387-392
        • Koot H.M.
        • De Waard-Van Der Spek F
        • Peer C.D.
        • Mulder P.G.H.
        • Oranje A.P
        Psychosocial sequelae in 29 children with giant congenital melanocytic naevi.
        Clin Exp Dermatol. 2000; 25: 589-593
        • Bellier-Waast F.
        • Perrot P.
        • Duteille F.
        • Stalder J.F.
        • Barbarot S.
        • Pannier M.
        Prise en charge chirurgicale des naevi géants congénitaux : quel retentissement psychosocial sur l'enfant et son entourage ?.
        Ann Chir Plast Esthet. 2008; 53: 408-414
        • Slutsky J.B.
        • Barr J.M.
        • Femia A.N.
        • Marghoob A.A.
        Large congenital melanocytic nevi: associated risks and management considerations.
        Semin Cutan Med Surg. 2010; 29: 79-84
        • Yamamoto Y.
        • Minakawa H.
        • Sugihara T.
        • Shintomi Y.
        • Nohira K.
        • Yoshida T.
        • et al.
        Facial reconstruction with free-tissue transfer.
        Plast Reconstr Surg. 1994; 94: 483-489
        • Gur E.
        • Zuker R.M.
        Complex facial nevi: a surgical algorithm.
        Plast Reconstr Surg. 2000; 106: 25-35
        • Gosain A.K.
        • Santoro T.D.
        • Larson D.L.
        • Gingrass R.P.
        Giant congenital nevi: a 20-year experience and an algorithm for their management.
        Plast Reconstr Surg. 2001; 108: 622-636
        • Arad E.
        • Zuker R.M.
        The shifting paradigm in the management of giant congenital melanocytic nevi: review and clinical applications.
        Plast Reconstr Surg. 2014; 133: 367-376
        • Tønseth K.A.
        • Filip C.
        • Hermann R.
        • Vindenes H.
        • Høgevold H.E.
        Extraordinary large giant congenital melanocytic nevus treated with integra dermal regeneration template.
        Plast Reconstr Surg Glob Open. 2015; 3: 1-3
        • Corcoran J.
        • Bauer B.S.
        Management of large melanocytic nevi in the extremities.
        J Craniofac Surg. 2005; 16: 877-885