Biologically Active Large Congenital Nevi

A 3-year-old girl was brought by her parents for advice regarding a pigmented lesion that had been present since her birth. The parents noted recent changes in its appearance--namely the development of “bumps” within a formerly “flat” lesion.

Key point: While not precisely quantifiable, large congenital nevi carry a risk of malignant degeneration. In this case, the lesion was clearly biologically active, having already developed exophytic extensions. My recommendation was for complete removal.

Treatment: Following the use of tissue expanders, surgical excision was done in a staged manner.

Note: While laser ablation has been championed by some experts, the latter approach is a blind procedure; nests of cells may remain deep in the skin, under scar tissue. Should melanoma develop, its recognition may therefore be delayed.