Children can be born with pigmented moles called congenital nevi (or nevus, if singular). These represent a proliferation of melanocytes, the pigment-producing cells of the skin. When they occur, congenital melanocytic nevi can be highly varied in size and shape. They may be very small and insignificant in appearance to very big, covering large areas of the body. Small congenital nevi are those less than 1.5cm in size. Giant nevi are those measuring 20cm or more in size at birth. The goal of giant nevi removal surgery is to remove the mole in its entirety or at least as much as is possible.
Who are Candidates, and what are the symptoms ?
If you’re unhappy with the appearance of a mole or are concerned that an irregularly shaped or colored mole may be cancerous, you are likely the perfect candidate for mole removal. This treatment option is safe and effective for most patients regardless of age, skin type, or skin tone.
Congenital nevi are thought to be caused by a genetic mutation, called a sporadic mutation, which develops randomly as a baby grows in the womb. The condition is not inherited.
Congenital nevi (the plural of nevus) can be many colors and may reflect the background color of the skin. Most congenital nevi are a shade of brown.
Long, dark or thick hair may be present in the nevus when it first appears or can develop over time.
You will see a consultant or plastic surgeon. They will perform a thorough mole check, and discuss the recommended procedure and costs, if necessary. We will also discuss with you any concerns and questions about the chosen treatment, recovery, risks and likely outcomes
The necessity for removal of a congenital nevus and the process used to remove it tend to vary depending on the location, size, and perceived risk of the condition. Treatment can range from observation to simple excision to excision and complex reconstruction.
Small- and medium-sized nevi are generally harmless but can be removed for aesthetic reasons. Removal of a small nevus consists of a simple excision, cutting out the affected area and stitching the surrounding skin back together.
Removing a large nevus is a much more daunting process.
Depending on the magnitude of the condition, the nevus is cut out in sections. The skin must be replaced via skin grafting or tissue expansion. Oftentimes, this requires multiple surgical procedures and a complex reconstruction process.
Laser congenital nevus treatment is also an emerging option, but results are inconsistent in terms of success rate and eventual re-pigmentation.
There are several different plastic surgery techniques used to remove moles of different sizes. Giant nevi are typically approached in one of three ways:
Serial excision involves the removal of one portion of the lesion with primary closure of the wound followed by a similar additional surgery or surgeries to remove the remaining lesion. Between each surgical stage the patient will be allowed to heal, and the scars and tissues start to soften and/or stretch to allow for re-excision without too much tension on the repaired incision.
Excision and grafting involve the removal of most or all of the lesion and closure of the skin defect with a skin graft from the patient or with skin substitutes. This technique allows for rapid removal of the abnormal tissue with fewer surgeries at the expense of a cosmetic wound closure. Skin grafts can leave more significant scarring and may prolong post-operative recovery time.
Tissue expansion is a technique invented to grow additional skin that can then be used as a skin flap or full thickness skin graft. During tissue expansion one or more silicone balloons are placed under the skin and then subsequently inflated with water over several weeks until the desired growth of skin is reached. By expanding available normal skin adjacent to the nevus, part or all of the nevus can ultimately be removed and then the extra skin used to replace the missing tissue and close the defect. Depending on the size of the lesion this process may need to be repeated to achieve near or complete removal of the lesion.
Sometimes these techniques are used together to treat this problem. For instance, a large lesion may first be serially excised to make it smaller until the skin is too tight to allow further excision at which point removal and grafting, or tissue expansion and flap closure may be considered to complete the process.
Is it Safe?
The possible risks of giant nevi removal surgery include, but are not limited to :
Is it painful?
Although a large nevus doesn’t generally cause pain, some aspects of the affected skin can be uncomfortable. Nevus skin can itch. Also, since there is often a lack of fatty tissue under a nevus, it isn’t as well padded as other parts of the body so it may be more affected by continuous pressure.
You may notice some mild tenderness in the treated area for the first 1-4 days after your mole removal. This is normal and typically subsides as the skin begins to heal. You should plan to keep the treatment site clean and covered with a bandage for 1-2 days to protect the area. After this time, you can remove the bandage and continue to keep the area clean and moisturized. Your doctor will inspect the area 1-2 weeks after your appointment to check on your healing progress.
Most treated sites heal completely in less than a month, although a larger or deeper incision could take 4-6 weeks to heal. After this time, you should continue to protect the area from the sun and may wish to explore scar fading treatments. However, the vast majority of patients find that any scar created by removal fades naturally over the first year as the skin heals. Once your final results are visible, you should see no evidence of your mole. In most cases, you’ll be able to enjoy your newly smooth skin permanently.
Surgical removal of part of your skin will leave a scar. How much of a scar depends on all these same factors again. Different patients are more prone or less prone to significant scarring. If there is a lot of skin tension where the surgery took place, this can cause more scarring. If a large area was removed, this will result in more scarring than if a small area was removed. If the surgeon is not skilled, the scarring could be worse than if the surgeon is more skilled. you should avoid touching or stretching the treated area as much as possible to keep the skintight and undisturbed as it heals. You should also avoid the sun, which can damage the healing area, and always wear sunscreen when you spend time outside.
Things to keep in mind
- Although information about congenital pigmented nevus removal is often the first thing a new nevus parent wishes to learn about, removal is certainly not always the best option. Every case is different, and removal is a personal decision that must be made with the help of an experienced doctor.
- Nobody knows absolutely for sure if removing a nevus reduces or removes the risk of skin cancer. Since skin cancer is so common, there is no way of knowing if a person with a large, pigmented nevus actually got it because they have a large nevus, or if it would have occurred even if they had been born without a nevus. Common sense dictates that it’s likely that having a large congenital melanocytic nevus increases the chances of skin cancer, but « how much? » remains to be better understood. Common sense also dictates that removing some melanocytes from the skin should reduce the risk of skin cancer, but again, more information is needed to determine the actual benefits.