1
|
Soong LC, Bencivenga A, Fiorillo L. Neonatal Curettage of Large to Giant Congenital Melanocytic Nevi Under Local Anesthetic: A Case Series With Long-Term Follow Up. J Cutan Med Surg 2021; 26:149-155. [PMID: 34792421 PMCID: PMC8950714 DOI: 10.1177/12034754211057751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Neonatal curettage of large to giant congenital melanocytic nevi (L-GCMN) is a simple, minimally invasive procedure typically performed within the first 2 weeks of life. Objectives To retrospectively review our experience with serial curettage of L-GCMN in the neonatal period performed under local anesthesia and their long-term outcomes. Methods Curettage was performed by a single pediatric dermatologist on nine neonates with L-GCMN under local anesthetic and with oral analgesia between 2002 and 2016 in Red Deer, Alberta, Canada. Patient charts were reviewed retrospectively to assess patient and procedure characteristics, tolerability, safety, cosmetic and functional outcomes, and malignant transformation. Results Patients were treated with an average of 6 curettage sessions (range 3 to 15) to remove the majority or entirety of the nevus. All patients tolerated local anesthesia well. The most common adverse event of the procedure was transient neutropenia. Two patients developed positive bacterial cultures without clinical signs of infection, treated with antibiotics. All curetted specimens demonstrated benign pathology. Patients were followed annually thereafter, for an average of 6 years. Eight patients with L-GCMN of the trunk had minimal to partial repigmentation with good cosmetic outcome. One patient had recurrence of a facial nevus. None of the patients developed cutaneous malignant melanoma. Conclusions Curettage appears to be a safe and effective treatment option for select cases of L-GCMNs of the trunk. We do not recommend the procedure for face or scalp CMN. This procedure can be performed under local anesthesia with serial curettage to avoid potential risks of general anesthesia.
Collapse
Affiliation(s)
- Laura C Soong
- 3158 Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Loretta Fiorillo
- 3158 Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
2
|
Morimoto N, Mitsui T, Katayama Y, Kakudo N, Ogino S, Tsuge I, Sakamoto M, Hihara M, Kusumoto K. Cultured epithelial autografts for the treatment of large-to-giant congenital melanocytic nevus in 31 patients. Regen Ther 2021; 18:217-222. [PMID: 34377751 PMCID: PMC8313801 DOI: 10.1016/j.reth.2021.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/01/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Giant congenital melanocytic nevus (GCMN) is a large melanocytic nevus, and its full-thickness removal is usually difficult due to the lack of skin available for reconstruction. Curettage is an alternative approach in cases of GCMN to remove the superficial dermis above the cleavage plane with a curette in the neonatal period, and its major complications include repigmentation, retarded epithelization, and hypertrophic scar formation. In Japan, the JACE® cultured epidermal autograft (CEA) was approved and covered by public healthcare insurance for the treatment of congenital melanocytic nevus (CMN) that is difficult to treat with conventional methods in 2016. We have used CEA for wounds after curettage in the neonatal period or following ablation after the neonatal period in combination with laser therapies to reduce the above-mentioned complications. Methods In this study, we summarized all consecutive CMN patients treated using CEA from December 2016 to April 2019 and evaluated the duration required for epithelialization, incidence of hypertrophic scar, and color change in the target nevus by comparing the L∗ values one year later between the Curettage group, the non-Curettage group with initial treatment or the subsequent group. Results No significant differences were seen in the epithelization period or incidence of hypertrophic scars among the groups, but the color of the target nevus was improved significantly in the Curettage group (p < 0.01) and non-Curettage group with initial treatment (p < 0.01). Conclusions In conclusion, CEA seems to accelerate epithelization after curettage or ablation of CMN, and this treatment could improve the color of CMN when applied initially.
Collapse
Affiliation(s)
- Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Japan
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto University, Japan
- Corresponding author. 54,Kawahara-cho Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan. Fax: + 81-75-751-4340
| | - Toshihito Mitsui
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Japan
| | - Yasuhiro Katayama
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto University, Japan
| | - Natsuko Kakudo
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Japan
| | - Shuichi Ogino
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto University, Japan
| | - Itaru Tsuge
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto University, Japan
| | - Michiharu Sakamoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto University, Japan
| | - Masakatsu Hihara
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Japan
| | - Kenji Kusumoto
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Japan
| |
Collapse
|
3
|
Molinelli A, Cozzani E, Burlando M, Santi P, Parodi A, Ventura F. Spastic quadriplegia following intradermal use of hydrogen peroxide in the tardive curettage procedure for the treatment of a giant congenital nevus. GIORN ITAL DERMAT V 2021; 155:780-782. [PMID: 33645938 DOI: 10.23736/s0392-0488.16.05231-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The possible transformation of a giant congenital melanocytic nevi (GCMN) in malignant melanoma estimated from 0.05% to 40% depend on the size of the lesions. Many are the surgical procedures proposed, including: full or partial-thickness excisions, dermabrasion, curettage in the first weeks of life and laser treatment. The curettage technique has been proposed in the literature for the treatment of GCMN in the first few weeks of life and defined as a relatively atraumatic surgery procedure without general complications. The authors report the first case in the literature of embolization due to use of subcutaneous peroxide infiltration before a tardive curettage procedure in a newborn case of GCMN resulting in spastic quadriplegia with dystonic reaction. Consequently, a lawsuit, due to this medical malpractice, has been opened.
Collapse
Affiliation(s)
- Andrea Molinelli
- Department of Legal Medicine, IRCCS San Martino University Hospital, Genoa, Italy
| | - Emanuele Cozzani
- Department of Dermatology, Di.S.Sal., IRCCS San Martino University Hospital, Genoa, Italy -
| | - Martina Burlando
- Department of Dermatology, Di.S.Sal., IRCCS San Martino University Hospital, Genoa, Italy
| | - Pierluigi Santi
- Department of Plastic Surgery, IRCCS San Martino University Hospital, Genoa, Italy
| | - Aurora Parodi
- Department of Dermatology, Di.S.Sal., IRCCS San Martino University Hospital, Genoa, Italy
| | - Francesco Ventura
- Department of Legal Medicine, IRCCS San Martino University Hospital, Genoa, Italy
| |
Collapse
|
5
|
Dégardin N, Jaloux C, Mallet S, Hesse S, Bardot J. [Skin tumors in children]. ANN CHIR PLAST ESTH 2016; 61:498-512. [PMID: 27374221 DOI: 10.1016/j.anplas.2016.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 05/30/2016] [Indexed: 11/28/2022]
Abstract
The presence of a congenital or acquired cutaneous lesion is a frequent reason for consultation in pediatric plastic surgery unit. The management of these lesions requires a good knowledge of specific diagnoses in children. This step is sometimes difficult because of the multiplicity of possible diagnosis. Some skin tumors may be the external sign of a general disease or an underlying malformation; those can change the overall prognosis and management and require to be properly identified. The decision of surgical excision depends on various criteria, including diagnosis but also the reconstruction possibilities. The timing of surgical treatment depends on the medical emergency of the tumor resection (benign tumor, spontaneously regressive tumor, risk of degeneration into malignancy), on the cosmetic and psychological impact but also on the growth or learning steps in child life. This article first provides an aid in the diagnosis of the most common or more characteristic skin tumors. The algorithm is principally based on the pigmentation aspect of the tumor. The age and conditions of the surgical management are specified for each type of tumor. Cutaneous hemangiomas and vascular malformations, and congenital cysts and fistulas are not reported in this article.
Collapse
Affiliation(s)
- N Dégardin
- Service de chirurgie plastique pédiatrique, hôpital Timone-Enfants, CHU de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
| | - C Jaloux
- Service de chirurgie plastique pédiatrique, hôpital Timone-Enfants, CHU de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - S Mallet
- Unité de dermatologie pédiatrique, hôpital Timone CHU de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - S Hesse
- Unité de dermatologie pédiatrique, hôpital Timone CHU de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - J Bardot
- Service de chirurgie plastique pédiatrique, hôpital Timone-Enfants, CHU de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| |
Collapse
|
6
|
Adjadj L, Debelmas A, Franois-Fiquet C, Diner PA, Buis J, Franchi G, Chrétien-Marquet B, Vazquez MP, Picard A, Kadlub N. [Orbital congenital nevi: Principles of treatment about 51 cases]. ANN CHIR PLAST ESTH 2014; 61:29-38. [PMID: 25524448 DOI: 10.1016/j.anplas.2014.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 11/08/2014] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The incidence of congenital nevi is one over 20,000 newborns per year, 14 % of them are located in the head and neck area. Nevi of the orbital region are particularly difficult to handle on the aesthetic and functional side. The objectives of this study were to conduct an analysis of different clinical presentations of congenital nevi of the eyelid orbital region in children to establish a treatment algorithm. MATERIEL AND METHODS We realised a bi-centric retrospective study including 51 children with orbito-palpebral congenital nevi. We analysed the different clinical presentations, their treatments and their results. RESULTS Nineteen underwent direct suture excision; three a total skin graft; 15 a combination of treatments, among them four underwent tissular expansion and 14 patients were not operated and clinically followed-up. The average follow-up time was 6.6 years. In 33 cases residual nevic area was still present. The postoperative sequelae were: dyschromia (n=17), anatomical deformation of the eye (n=10), nevi outbreaks (n=8), internal canthus deformation (n=5) and ectropion (n=1). CONCLUSION The results of our study show that therapeutic abstention is preferred when the aesthetic wrong is accepted by the patient and when there is not a higher risk of malignant degeneration. In order to minimise the risk of postoperative sequelae, we propose a therapeutic algorithm for the management of congenital orbital nevi.
Collapse
Affiliation(s)
- L Adjadj
- Service de chirurgie maxillo-faciale et plastique, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - A Debelmas
- Service de chirurgie maxillo-faciale et plastique, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - C Franois-Fiquet
- Service de chirurgie plastique, CHU de Reims, 51000 Reims, France; UFR de médecine, université de Reims-Champagne-Ardennes, 51000 Reims, France
| | - P-A Diner
- Service de chirurgie maxillo-faciale et plastique, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Centre de référence des malformations faciales et de la cavité buccale, MAFACE, AP-HP, 75015 Paris, France
| | - J Buis
- Service de chirurgie maxillo-faciale et plastique, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Centre de référence des malformations faciales et de la cavité buccale, MAFACE, AP-HP, 75015 Paris, France
| | - G Franchi
- Service de chirurgie maxillo-faciale et plastique, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Centre de référence des malformations faciales et de la cavité buccale, MAFACE, AP-HP, 75015 Paris, France
| | - B Chrétien-Marquet
- Service de chirurgie maxillo-faciale et plastique, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - M-P Vazquez
- Service de chirurgie maxillo-faciale et plastique, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Centre de référence des malformations faciales et de la cavité buccale, MAFACE, AP-HP, 75015 Paris, France; Université Paris Descartes, 75005 Paris, France; UMRS 972, équipe 5, Inserm, centre de recherche des Cordeliers, 75006 Paris, France
| | - A Picard
- Service de chirurgie maxillo-faciale et plastique, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Centre de référence des malformations faciales et de la cavité buccale, MAFACE, AP-HP, 75015 Paris, France; Université Paris Descartes, 75005 Paris, France; UMRS 972, équipe 5, Inserm, centre de recherche des Cordeliers, 75006 Paris, France
| | - N Kadlub
- Service de chirurgie maxillo-faciale et plastique, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Centre de référence des malformations faciales et de la cavité buccale, MAFACE, AP-HP, 75015 Paris, France; Université Paris Descartes, 75005 Paris, France; UMRS 972, équipe 5, Inserm, centre de recherche des Cordeliers, 75006 Paris, France.
| |
Collapse
|