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Congenital Melanocytic Nevi: Where Are We Now?

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Congenital Melanocytic Nevi: Where Are We Now? Congenital melanocytic nevi: Where are we now? Part II. Treatment options and approach to treatment Omar A. Ibrahimi, MD, PhD,a,b Ali Alikhan, MD,c and Daniel B. Eisen, MDd Farmington, Connecticut; Boston, Massachusetts; Rochester, Minnesota; and Sacramento, California CME INSTRUCTIONS The following is a journal-based CME activity presented by the American Academy of available for their efficacy or lack thereof; and formulate a rational treatment Dermatology and is made up of four phases: approach. 1. Reading of the CME Information (delineated below) Date of release: October 2012 2. Reading of the Source Article Expiration date: October 2015 3. Achievement of a 70% or higher on the online Case-based Post Test 4. Completion of the Journal CME Evaluation Ó 2012 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2012.06.022 CME INFORMATION AND DISCLOSURES Statement of Need: Technical requirements: The American Academy of Dermatology bases its CME activities on the Academy’s American Academy of Dermatology: core curriculum, identified professional practice gaps, the educational needs which d Supported browsers: FireFox (3 and higher), Google Chrome (5 and higher), underlie these gaps, and emerging clinical research findings. Learners should reflect Internet Explorer (7 and higher), Safari (5 and higher), Opera (10 and higher). upon clinical and scientific information presented in the article and determine the d JavaScript needs to be enabled. need for further study. Target Audience: Elsevier: Dermatologists and others involved in the delivery of dermatologic care. Technical Requirements This website can be viewed on a PC or Mac. 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Learning Objectives After completing this learning activity, participants should be able to identify Elsevier: http://www.elsevier.com/wps/find/privacypolicy.cws_home/ treatments available for congenital melanocytic nevi; discuss the evidence privacypolicy 515.e1 515.e2 Ibrahimi, Alikhan, and Eisen JAM ACAD DERMATOL OCTOBER 2012 Treatment of congenital melanocytic nevi (CMN) is generally undertaken for 2 reasons: (1) to reduce the chances of cutaneous malignant melanoma and (2) for cosmetic reasons. Over the past century, a large number of treatments for CMN have been described in the literature. These include excision, dermabrasion, curettage, chemical peels, radiation therapy, cryotherapy, electrosurgery, and lasers. Only low-level evidence supporting these approaches is available, and large randomized controlled trials have not been published. This article explores therapeutic controversies and makes recommendations based on the best available evidence. ( J Am Acad Dermatol 2012;67:515.e1-13.) The treatment of congen- d High rates of satisfac- ital melanocytic nevi (CMN) CAPSULE SUMMARY tion have been reported before the development of for excision when CMN malignancy is considered d Excision has been recommended as the are \20 cm in size, es- for 2 reasons: (1) to reduce first-line treatment for congenital nevi in pecially for those on the chances of cutaneous which treatment is indicated. the head and neck malignant melanoma (MM) d Data regarding the purported benefits Excision can be per- and (2) for cosmetic reasons. and risks of these procedures are formed either for cosmetic The treatment of giant CMN explored. (GCMN) is technically diffi- reasons or to attempt to re- d Excision may result in high satisfaction, duce the risk of development cult, and complete removal but its efficacy at reducing the incidence of MM. Given that CMN may of these lesions is often of malignant melanoma is unproven. penetrate deeply, excision to impossible. Approaches to d the level of the fascia is ad- removal can broadly be Fears regarding the use of lasers for vocated in order to assure classified into 2 groups: treatment are unsubstantiated, but removal of as much of the full- and partial-thickness treatment effectiveness with lasers has lesion as possible and to removal procedures (Table been variable. I). Full-thickness procedures avoid recurrence. However, the excision of CMN to re- remove the entire dermis and duce the chance of malignancy is controversial. epidermis and varying amounts of subcutaneous Proponents claim that the removal of these nevi tissue. They are likely to remove more nevus cells reduce the risk of associated MM.1 Although the than partial-thickness procedures, but the effective- absolute risk of MM in many studies appears to be ness of either method for preventing future malig- low, it is still considerably higher than the general nancy remains a topic of debate. It is important to population.1 In addition, the true lifetime risk of MM stress that lifelong surveillance is warranted regard- may be underestimated given the skewing towards a less of if partial- or full-thickness treatments are younger average age of patients in many studies. In undertaken. the case of GCMN,
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