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Carbon Dioxide Cryotherapy for Treatment of Nasal and Perinasal Congenital Melanocytic Nevi. Ann Plast Surg 2020; 85:107-109. [PMID: 31929337 DOI: 10.1097/sap.0000000000002145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Congenital melanocytic nevi, reported in 1% to 6% of newborns. There are many complications the most dangerous is the malignant transformation, but the most depressive is the cosmetic one specially for facial lesions. There is a wide range of treatment modalities none of them provide an acceptable solution for facial lesions. In this study we provide a simple, cheap and effective treatment modality for nasal and perinasal congenital melanocytic nevi. In our study, significant improvement was observed with no repigmentation throughout the follow-up period. We conclude that carbon dioxide cryotherapy is an effective treatment modality for nasal and perinasal congenital melanocytic nevi that should be used by others to stand on its long-term persistence and possible complications.
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Wanner M, Sakamoto FH, Avram MM, Anderson RR. Immediate skin responses to laser and light treatments. J Am Acad Dermatol 2016; 74:807-19; quiz 819-20. [DOI: 10.1016/j.jaad.2015.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 05/29/2015] [Accepted: 06/03/2015] [Indexed: 12/23/2022]
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Arora H, Falto-Aizpurua L, Chacon A, Griffith RD, Nouri K. Lasers for nevi: a review. Lasers Med Sci 2014; 30:1991-2001. [PMID: 25512060 DOI: 10.1007/s10103-014-1697-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/03/2014] [Indexed: 10/24/2022]
Abstract
A nevus is described as a benign, often pigmented, skin growth that can be congenital or acquired. Different types of nevi are located at different depths within the skin. Traditional treatments for nevi include topical treatments, dermabrasion, and excision, which are generally ineffective, invasive, and often result in scars and dyspigmentation. Lately, laser therapy has been used as an alternative. Based on the theory of selective photothermolysis, melanin can be specifically targeted, minimizing adverse effects and increasing effectiveness of laser treatments. Several types of lasers and lights have been studied for this purpose without a concise agreement as to which is the best. In general, quality-switched lasers are preferred for the treatment of pigmented lesions. However, there is controversy about this therapy because certain nevi may have malignant potential. This article serves as a comprehensive review of available laser treatments for nevi and discusses the appropriate measures that should be taken before and after laser therapy. Based on the reviewed literature, laser treatment has generally been proven to be a safe and effective therapy for nevi with minimal side effects.
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Affiliation(s)
- Harleen Arora
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1475 NW 12th AVE, Miami, FL, 33136, USA,
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Liem PH, Morimoto N, Ito R, Kawai K, Suzuki S. Autologous skin reconstruction by combining epidermis and acellular dermal matrix tissue derived from the skin of giant congenital melanocytic nevi. J Artif Organs 2013; 16:332-42. [PMID: 23644894 DOI: 10.1007/s10047-013-0708-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 04/10/2013] [Indexed: 01/12/2023]
Abstract
Giant congenital melanocytic nevi (GCMN) are defined as nevi greater than 20 cm in diameter. It is difficult to completely remove GCMN because of the lack of available skin grafts for covering the resultant defects. This study examined whether it is possible to produce reconstructed skin by combining epidermal and acellular dermal matrix (ADM) tissue derived from excised GCMN. GCMN skin samples were obtained with the informed consent of volunteer patients. The abilities of hypertonic saline (1 N NaCl), 0.05% trypsin, 0.1% SDS (sodium dodecyl sulfate), and phosphate buffered saline (PBS) to decellularize GCMN tissue were compared. The specimens were incubated in one of the test solutions at 37 °C for 48 h, before being washed with PBS at 4 °C for 14 days. Residual nuclei, residual DNA, nevus tissue viability, and the structural integrity of the basement membrane and capillaries were evaluated before treatment, and after 48 h' treatment with or without 7 or 14 days' washing. We tried to produce reconstructed skin by combining the resultant ADM with enzymatically separated GCMN epidermal tissue. The histological structure of the reconstructed skin was examined after it had been cultured for 5 days. In the SDS group, most cells had been removed after 48 h, and the DNA content of the ADM was significantly lower than in the other groups. As for viability, no significant difference was detected among the groups. The basement membrane and capillaries remained intact in all groups. After 5 days' culturing, the epidermis had become attached to the ADM in all groups, except the SDS group. SDS displayed a superior decellularization ability compared with the other methods; however, it cannot be used to produce reconstructed skin because of its toxicity. In conclusion, we produced reconstructed skin that was devoid of nevus cells by combining GCMN epidermal tissue with GCMN-derived ADM produced with NaCl or trypsin. This is a promising treatment strategy for giant nevus.
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Affiliation(s)
- Pham Hieu Liem
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan,
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Turkmen A, Isik D, Bekerecioglu M. Comparison of classification systems for congenital melanocytic nevi. Dermatol Surg 2010; 36:1554-62. [PMID: 20584038 DOI: 10.1111/j.1524-4725.2010.01641.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Congenital melanocytic nevi (CMNs) are found in approximately 1% of newborn infants, but these represent only a small proportion of the total population of nevi. They vary widely in size, from a small spot to a large area. Later in childhood, these lesions become thickened, verrucous, and hairy. Giant CMNs predispose to malignant melanoma, with a reported incidence of 2% to 31%. OBJECTIVE To compare three different classification methods of the CMNs to determine which is most accurate. PARTICIPANTS AND METHODS Sixty patients were included in the study (34 male, 26 female), with an average age of 17.4 (range 3-32). The nevi were evaluated using three different classification methods: total area of the nevus (in cm(2)), greatest nevus dimension, and percentage of nevus surface area to total patient body surface area. An appropriate treatment procedure for each case was applied, and participants were followed from 1997 to 2007. RESULTS Malignant transformation was noted in 15.4% of participants with congenital nevi, which was confirmed histopathologically after excision. CONCLUSION We recommend the calculation of total nevus area as the most useful method for assessment of the risk of developing melanoma in a CMN. The authors have indicated no significant interest with commercial supporters.
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Affiliation(s)
- Arif Turkmen
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Gaziantep University Medical Faculty, Gaziantep, Turkey.
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Chien JC, Niu DM, Wang MS, Liu MT, Lirng JF, Chen SJ, Hwang B. Giant congenital melanocytic nevi in neonates: report of two cases. Pediatr Neonatol 2010; 51:61-4. [PMID: 20225541 DOI: 10.1016/s1875-9572(10)60012-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Giant congenital melanocytic nevi are rare, with an estimated incidence of approximately 1 in 20,000 live births. They increase the lifetime risk for malignant melanoma and neurological deficits, including leptomeningeal melanocytosis and epilepsy. Recently, we encountered two patients in whom giant congenital melanocytic nevi were noted at birth. Case 1 presented with the largest nevus spreading across the posterior scalp, neck, chest wall, shoulder and upper back. At the age of 2 months, magnetic resonance imaging (MRI) was performed and no leptomeningeal melanocytosis was found. Case 2 presented with a huge nevus covering most parts of the lower abdomen, lower back, buttocks and bilateral upper thighs. She also had normal MRI findings in the newborn period. At the age of 7 years, leptomeningeal thickening on the surface of the junction between the pons and midbrain was found on brain MRI although she was neurologically asymptomatic. Here, we describe these two cases with congenital melanocytic nevi and review the literature about its clinical manifestations, outcomes, risks for malignant melanoma and neurocutaneous melanosis, and possible surgical interventions.
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Affiliation(s)
- Jen-Chung Chien
- Department of Pediatrics, Lo-Tung Pohai Hospital, Ilan, Taiwan
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Abstract
Congenital nevi are benign neoplasms that are present at birth and composed of nevomelanocytes. Approximately 1-3% of all newborns have congenital pigmented nevi, and the number of nevi increases with age, peaking by late adolescence to 20-40 nevi in an individual. Giant congenital nevi are often defined as nevi that are greater than 20 cm in diameter in an adult, or nevi that occupy 2% or more of the body surface area. Histologically, nevi are transformed melanocytes, which are normally highly dendritic cells interspersed among basal keratinocytes. The genetic basis of these lesions is not known. Findings of a culture of melanocytes from such a lesion from a showed chromosome rearrangements involving 1p,12q, and 19p. The giant nevi might be associated to several diseases: neurocutaneous melanosis, diffuse lipomatosis, structural brain malformations, hypertrophy of skull bones, limb atrophy, skeletal asymmetry involving both soft tissue hyper-and hypoplasia, von Recklinghausen's disease and vitiligo. The risk of malignant change in giant nevi is probably the most contentious issue in its management. The consensus is that lesions are pre-malignant, but the purported incidence of malignancy varies wildly from 0-42%. Surgical excision remains the mainstay of treatment for large congenital melanocytic nevi, and most giant nevi are managed by staged excision and resurfacing with skin grafts or tissue expanders and flaps.
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Affiliation(s)
- Connie Chung
- Section of Plastic Surgery, Yale University School of Medicine, New Haven, CT, USA
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Kobayashi S, Kubo K, Matsui H, Torikai K, Kuroyanagi Y. Skin Regeneration for Giant Pigmented Nevus Using Autologous Cultured Dermal Substitutes and Epidermis Separated From Nevus Skin. Ann Plast Surg 2006; 56:176-81. [PMID: 16432327 DOI: 10.1097/01.sap.0000197199.40281.76] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We have developed a modality of treatment of giant pigmented nevus of intradermal type. This method involves application of autologous cultured dermal substitute (CDS), followed by grafting of epidermis separated from the patient's nevus skin. To prepare the wound bed, autologous CDS was applied onto a full-thickness skin defect after complete excision of the nevus. The excised nevus skin was preserved for 1 week, after which the epidermis was separated from the nevus skin by enzymatic treatment with dispase. The epidermis thus obtained was grafted onto the resulting wound bed. This procedure was used to treat a giant pigmented nevus on a 7-year-old patient. The grafted region was soft with good tone 1 year after epidermis grafting. These results indicate that the present method can achieve complete excision of giant nevus, with esthetically acceptable results, although it requires careful monitoring for a long time.
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Affiliation(s)
- Shinji Kobayashi
- Department of Plastic and Reconstructive Surgery, Kanagawa Children's Medical Center, Yokohama, Japan.
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Abstract
Congenital nevi are benign proliferations present at birth that consist of cells normally present in the skin. Many of these lesions are disfiguring and a source of psychosocial impairment. Because of location or extent of the lesion, surgical excision of the nevus may leave a defect without favorable reconstructive options. Laser ablation of such lesions has been used by several clinicians. A review of laser terminology is presented along with a review of nevus of Ota, nevus of Ito, café-au-lait macules, lentigines, and congenital melanocytic nevi. Although good results may be achieved with laser ablation of these lesions, laser treatment modalities for congenital melanocytic nevi remain controversial because of the potential for malignancy.
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Affiliation(s)
- Robert E H Ferguson
- Division Plastic Surgery, Department of Surgery, University of Kentucky Chandler Medical Center, Lexington, Kentucky, USA
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Kono T, Erçöçen AR, Nozaki M. Treatment of Congenital Melanocytic Nevi Using the Combined (Normal-Mode Plus Q-Switched) Ruby Laser in Asians. Ann Plast Surg 2005; 54:494-501. [PMID: 15838210 DOI: 10.1097/01.sap.0000154866.01964.8c] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Clinical response of congenital melanocytic nevus (CMN) to the combined normal-mode ruby laser (NMRL) and Q-switched ruby laser (QSRL) treatment method (ie, NM plus QS) was correlated with the histologic depth of nevomelanocytic nests to predict the efficacy rate and therapeutic outcome of the laser treatment. Thirty-four patients with CMN were treated using the combined (NM plus QS) ruby laser method. The clinical results of the laser treatment demonstrated that 20 had excellent response, 11 had good response, 3 had fair response, and there was no poor response. When correlated with the histologic type, the efficacy rate of the combined ruby laser was significantly higher in the superficial intradermal type than in the others. We conclude that combining the NMRL and QSRL with appropriate parameters to target both superficial and deep nevomelanocytic components provides a greater degree of penetration of laser light.
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Affiliation(s)
- Taro Kono
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan.
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Laser literature watch. JOURNAL OF CLINICAL LASER MEDICINE & SURGERY 2004; 22:69-75. [PMID: 15117491 DOI: 10.1089/104454704773661010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Michel JL. Is Laser Therapy an Adequate Treatment for Giant Congenital Melanocytic Nevi? ACTA ACUST UNITED AC 2004. [DOI: 10.1078/1615-1615-00119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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