Giant Congenital Melanocytic Nevi of the Head and Neck: Clinical Update and Advances in Treatment

Abstract

Introduction: Giant congenital melanocytic nevi are rare lesions of various size, shape, color, and location with potential complications including malignant and neurocutaneous melanoma. Here we discuss the etiology and epidemiology of giant congenital melanocytic nevi, the indications and options for treatment, and current data regarding outcomes, as well as our preferred approach to patient management. Methods: Full text case reports, retrospective studies, prospective studies, clinical trials, and review articles regarding giant congenital melanocytic nevi in English were included in this analysis utilizing PubMed, MEDLINE, EMBASE, and Google scholar databases. Results: Giant congenital melanocytic nevi pose a difficult diagnostic and reconstructive challenge for the plastic surgeon. Indications for treatment depend on the size of the nevus, pigmentation, established melanoma, persistent symptoms, maintenance of function, and psychological burden. A multidisciplinary approach should be applied to establish an individualized treatment plan for patients with giant congenital melanocytic nevi. Numerous surgical and nonexcisional options have been illustrated for the management of these lesions. Chemical peels and laser ablation are among the most common non-surgical approaches. When considering surgical treatment for lesions with malignant potential, a multimodal approach is generally employed, including serial excision, excision with skin grafting and/or skin substitutes, and tissue expansion. Conclusion: A proper understanding of the disease’s histology, natural history, complications, and treatment options are essential in the management of these complex lesions.