Cosmetically Challenging Congenital Melanocytic Nevi

Evaluation and management of benign tumors of the eye and eyelid

Benign tumors of the eye and eyelid are common in children and adults, and they rarely undergo malignant transformation. Their workup and management have evolved over the years with increasing advancements in surgical and laser therapies. This contribution focuses on describing the following benign eye and eyelid tumors and their diagnostic and treatment approaches: congenital and acquired melanocytic nevi; nevus of Ota (Hori nevus); conjunctival papilloma; seborrheic keratosis; epidermoid cyst; dermoid cyst; milium; xanthelasma; hemangioma (cherry angioma and pyogenic granuloma); neurofibroma; neurilemmoma (schwannoma); and fibroepithelial polyp. Surgical removal is the primary treatment approach for many of these benign tumors. With advancements in laser technologies, there are now several laser types that can be used in the treatment of these benign eye and eyelid tumors. Other treatment modalities include cryosurgery, electrosurgery, and topical or intralesional medications. We hope this review will provide a reference to dermatologists and ophthalmologists in their approach to evaluation and management of benign eye and eyelid tumors.

Case report: Later onset of NRAS-mutant metastatic melanoma in a patient with a partially-excised giant congenital melanocytic nevus

Despite recent advances in treatment and surveillance, metastatic melanoma still carries a poor prognosis. Large/giant congenital melanocytic nevi (CMNs) constitute a known risk factor for the condition, with the greatest risk for malignant transformation thought to be during childhood (median age at diagnosis of 3 years in a previous cohort). Herein, we present the case of a 30-year-old male who, after undergoing multiple excision/grafting procedures for a giant CMN as a child, was diagnosed with an NRAS-mutant, MDM2-amplified metastatic melanoma more than 20 years later. Response to ipilimumab/nivolumab immunotherapy, cisplatin/vinblastine/temozolomide chemotherapy, and nivolumab/relatlimab immunotherapy was poor. This case highlights the importance of lifetime monitoring with once-yearly dermatological examination (including lymph node palpation) in large/giant CMN patients, as well as the need for further clinical trials evaluating novel therapies for NRAS-mutant melanoma.

Measurement instruments for the core outcome set of congenital melanocytic naevi and an assessment of the measurement properties according to COSMIN: a systematic review

Background

Congenital melanocytic naevi (CMN) can impact on patients' lives due to their appearance and the risk they carry of neurological complications or melanoma development. The development of a core outcome set (COS) will allow standardised reporting and enable comparison of outcomes. This will help to improve guidelines. In previous research, relevant stakeholders reached a consensus over which core outcomes should be measured in any future care or research. The next step of the COS development is to select the appropriate measurement instruments.

Aim

Step 1: to update a systematic review identifying all core outcomes and measurement instruments available for CMN. Step 2: to evaluate the measurement properties of the instruments for the core outcomes.

Methods

This study was registered in PROSPERO and performed according to the PRISMA checklist. Step 1 includes a literature search in EMBASE (Ovid), PubMed and the Cochrane Library to identify core outcomes and instruments previously used in research of CMN. Step 2 yields a systematic search for studies on the measurement properties of instruments that were either developed or validated for CMN, including a methodological quality assessment following the COSMIN methodology.

Results

Step 1 included twenty-nine studies. Step 2 yielded two studies, investigating two quality of life measurement instruments.

Conclusion

Step 1 provided an overview of outcomes and instruments used for CMN. Step 2 showed that additional research on measurement properties is needed to evaluate which instruments can be used for the COS of CMN. This study informs the instrument selection and/or development of new instruments.

Giant Congenital Melanocytic Nevus in a Pediatric Patient: Case Report

The giant congenital melanocytic nevus is a rare entity with an extremely low incidence that appears at the time of birth and generally involves the dermis but may also affect other skin layers. According to its clinical evolution, the probability of malignancy may vary, so proper follow-up is essential for potential management. There is no consensus in the literature about the greater benefit of surgical versus nonsurgical management. In this case report, we present the surgical management of a school-aged patient using dermal substitutes and skin grafts, subjectively obtaining an improvement in his quality of life.

Giant Congenital Melanocytic Nevi in a Pakistani Newborn

Congenital melanocytic nevi arise from overgrowth or disrupted migration of melanocyte precursor in the neural crest. They are also known as coat-sleeve, stocking, bathing trunk or garment nevi. The colour ranges from brown to black, with the lesions presenting as flat to raised nevi. Lesions presenting at birth with a diameter greater than 20cm are labelled giant congenital melanocytic nevi. Risk increases with an increase in the number of satellite lesions near the giant nevus. Management includes regular clinical follow-up monitoring of changes in the lesion and surgical procedures in cases with risk of melanoma and psychological support. The purpose of this case presentation is to describe a rare issue of giant congenital melanocytic nevi in a newborn, along with a literature review and discussion on possible management options.

Distribution Patterns (7B Rule) and Characteristics of Large Congenital Melanocytic Nevi: A Retrospective Cohort Study in China

Large congenital melanocytic nevus has a high risk of malignancy. However, few studies have summarized its characteristics, treatments, outcomes and malignancy incidence in Chinese patients. This paper reviews a retrospective cohort study evaluating 1,171 patients from Shanghai Ninth People's Hospital between 1 January 1989 and 31 August 2019 using electronic medical records and phone calls to collect clinical and pathological data in which 133 patients were diagnosed with a large congenital melanocytic nevus. Three patients relapsed, and none developed melanoma among the qualified patients. Besides, a new “7B” rule for distribution patterns of large congenital melanocytic nevi was proposed, including bonce, bolero, back, bathing trunk, breast/belly, body extremity, and body. The most common distribution pattern of large congenital melanocytic nevi was bonce, and all blue nevi distributed as bonce. Statistical analysis showed a significant difference (P = 0.0249) in the “7B” patterns between the melanocytic nevus and the neuronevus. In conclusion, the malignancy rate of large congenital melanocytic nevi is much lower in China than in other regions and people of other races. The pathology of large congenital melanocytic nevus may decide its “7B” distribution pattern.

Treatment of Congenital Melanocytic Nevi With a Dual-Wavelengths Copper Vapor Laser: A Case Series

Introduction: Congenital melanocytic nevus (CMN) is a severe challenge for dermatology. This pigmented skin lesion is undesirable for patients because of its localization in open areas of the body. Various visible and near-infrared laser systems and intense pulsed light (IPL) sources have been applied for CMN treatment. However, post-traumatic hyperpigmentation, structural changes, atrophy, and scarring due to non-specific thermal damage have been observed. Many patients have shown recurrence after treatment. Therefore, it highlights the need for testing new laser modalities for the management of CMN. Methods: Two adult II Fitzpatrick phototype patients (a 55-year-old male and a 30-year-old female) with middle-sized facial CMN (on the forehead and lower eyelid) are presented. All patients were treated with dual-wavelength copper vapor laser (CVL) radiation at 511 nm and 578 nm wavelengths with a power ratio of 3:2. The average power was 0.7-0.85 W with an exposure time of 0.3 seconds. The spot size amounted to 1 mm. Results: Both patients showed complete resolution of CMN after CVL treatments. CMN became crusted within a few days after the laser treatment and peeled off within seven days. No recurrences were observed during the follow-up period up to 24 months. Conclusion: The middle-sized CMN can be successfully treated with dual-wavelength CVL radiation.

Treatment of сongenital melanocytic nevus in infants and children by a dual-wavelengths copper vapor laser

Introduction.Congenital melanocytic nevus (CMN) is detected at birth or shortly after birth in 1% of infants. The localization of CMN in aesthetically significant areas causes a decline in child self-esteem and causes concern for his parents. Surgical excision of skin areas with CMN is associated with an increased risk of cosmetic side effects and is often followed by long-term stress conditions after the invasive intervention. Aim of the study.To evaluate the efficacy of the CMN removal in infants, children and adolescents with the dual-wavelengths copper vapor laser (CVL) radiation. Patients and Methods.Medium-sized (up to 9 cm) single CMN was treated in nine fair-skinned patients: seven girls and two boys, aged from 2 months to 16 years. The procedures were carried out at an average CVL power of 0.61.0 W, with a power ratio of 3:2 at 511 nm and 578 nm wavelengths, and an exposure time of 0.20.3 s. Light spot diameter 1 mm. The treatment was carried out during 210 sessions with an interval of 12 months between sessions. Results.In children and adolescents, the treatment of CMN with CVL dual-wavelengths radiation made it possible to achieve significant clarification of the involved area without hypertrophic scars. The duration of the healing of the irradiated area lasted 23 weeks. Side effects were manifested with subtle skin atrophy. Conclusion.The high efficacy of CVL removal of medium-sized CMN in infants and children using the dual-wavelengths CVL radiation without pronounced side effects allows introducing such an approach in the clinical practice of pediatric dermatologists and cosmetologists.