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.

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.

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

 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. 
 

Skin Diseases

A pigmented lesion present since birth prompted the parents of this 3-year-old to seek medical care. They noted recent changes: the development of “bumps” in a formerly “flat” lesion.