Clinical Analysis of Serial (Staged) Excision for Congenital Melanocytic Nevi: A Single-center Experience

Lee, Min Young; Byun, Ji Yeon; Whang, Kyu Kwang

Abstract

BACKGROUND
Serial (staged) excision of congenital melanocytic nevi (CMN) is an important treatment option for medium-sized CMN. However, few studies have investigated the outcomes of serial excision in detail.
OBJECTIVE
We report our experience regarding serial excision of CMN, including methods to effectively reduce the procedural stages and scar length.
METHODS
We retrospectively reviewed medical records of patients with CMN treated between 2008 and 2015; 33 patients (7 men and 26 women) underwent serial excision.
RESULTS
The CMN were located on the face (n=11), arms (n=6), legs (n=11), and other areas of the body (n=11), including the back (n=2), chest (n=1), deltoid region (n=1), and buttocks (n=1). The mean CMN area was 19.7 cm². The mean number of surgical stages was 2.2. The mean interval between surgeries was 10.6 months. A marginal S-shaped incision along both edges of the nevus was preferred over elliptical excision, to reduce scarring. Pulsed dye, erbium:yttrium-aluminum-garnet (YAG), neodymium-doped:YAG, and carbon dioxide fractional lasers were used to improve the final outcomes and minimize scarring.
CONCLUSION
Serial excision is an effective treatment option associated with greater patient satisfaction, particularly for medium-sized and hairy CMN. Conventional elliptical serial excision is associated with the formation of elongated scars and sacrifices normal skin adjacent to the lesion. The marginal S-shaped incision reduces scarring by dispersing mechanical tension on the scar without skin wastage. Compared with the elliptical excision method, the marginal S-shaped incision reduces the number of surgical stages and results in a cosmetically superior scar. Performing a marginal S-shaped incision is technically challenging in certain anatomical locations, such as the eyes, nose, and mouth. Therefore, it is necessary to combine this procedure with erbium:YAG and neodymium-doped:YAG ablation.