Giant congenital melanocytic nevi.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Define what is meant by a giant congenital melanocytic nevus and understand its histologic properties. 2. Know the natural history and potential complications associated with a giant congenital melanocytic nevus. 3. Outline the nonsurgical and surgical options available to treat a giant congenital melanocytic nevus.

BACKGROUND: Giant congenital melanocytic nevi are rare lesions with a propensity to degenerate to malignant melanoma. Certain lesions also may be associated with neurocutaneous melanosis, which can on occasion be symptomatic. Appropriate investigations include a screening magnetic resonance imaging scan, neurologic evaluation, and serial clinical observations for the development of cutaneous melanoma. A variety of nonsurgical and surgical options are possible for the treatment of giant congenital melanocytic nevi.

METHODS: A MEDLINE search was performed to gather all pertinent articles from 1955 to 2005.

RESULTS: Giant congenital melanocytic nevi are a difficult diagnostic and reconstructive challenge, requiring careful preoperative evaluation, staged surgical excision, and lifelong patient monitoring and follow-up. With proper treatment, patients can expect a decreased risk of melanoma, with the possibility for early detection and cure of melanoma, amelioration of symptoms, improved aesthetics and psychosocial sequelae, and maintenance of function.

CONCLUSION: The plastic surgeon treating these challenging lesions must have a solid working knowledge of the disease's histology, its natural history and complications, and the options for treatment.