Results of the early use of tissue expansion for giant congenital melanocytic naevi on the scalp and face

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Summary

Introduction

Giant congenital melanocytic naevi (GCMN) are uncommon, have a significant morbidity and require extensive treatment. This paper presents results after complete excision of GCMN on the scalp, forehead or periorbita after early tissue expansion. Based on 15 years of experience, we want to show that performing tissue expansion at a young age is advisable.

Patients and methods

We included 17 consecutive patients in whom 38 tissue expanders were used. Early and late complications were noted. Patients were seen for a clinical follow up in which scars and re-pigmentation were evaluated with a validated scar scale (POSAS).

Results

All GCMN could be excised completely with early tissue expansion. The age at treatment ranged from 4 months to 2 years of age. With a mean follow-up period of 8.7 years, mild re-pigmentation was seen in only three patients and none of the patients developed a malignant melanoma. Complication rates are comparable with the literature.

Conclusion

Tissue expansion is a good method for removing GCMN located at the scalp or face with good cosmetic and oncological results. Performing tissue expansion at a young age is advisable.

Section snippets

Patients and methods

CMN are defined as giant CMN (GCMN) whenever their size is larger than 1% of the total body surface area (TBSA) in the face/neck or more than 2% elsewhere on the body.5 As in burn wound measurements, the patient's palm of the hand (the fingers excluded) is taken as a reference for measuring 1%.

In this cross-sectional observational study all patients were included with GCMN involving scalp or periorbita, who needed TE as part of their operative management. If serial excision could be performed

Results

In our study GCMN at the scalp, forehead or face were excised completely after TE in 17 patients. All patients were seen for follow up. Distribution of age, sex and location of GCMN are shown in Table 1. Patients were followed up for an average of 8.7 years (range 1.5–16 years). Table 1 shows the re-pigmentation and POSAS scores of the patients. Both patients and observers scored the scars as moderate (Table 1). In addition, parents scored the overall impression of the scar formation in the

Discussion

In this paper we showed that GCMN at the scalp or forehead can be excised completely after early tissue expansion. By means of a validated evaluation tool we showed good cosmetic results. In our study period, covering 9 years, no cases of malignancy were observed.

Due to the small number of patients, statistical analyses could not be performed.

In seven patients (18% of the tissue expanders) expander-related complications occurred: exposure of the expander, implant failure or infection all of

Acknowledgements

The authors would like to thank P. P. M. van Zuijlen for providing the POSAS scale.

References (15)

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