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Journal of the American Academy of Dermatology
Volume 68, n° 3
page 493 (mars 2013)
Doi : 10.1016/j.jaad.2012.09.039
Reviews

Large congenital melanocytic nevi: Therapeutic management and melanoma risk : A systematic review
 

Morgane Vourc’h-Jourdain, MD a, , Ludovic Martin, MD, PhD b, Sébastien Barbarot, MD a

aRED

a Dermatology Department, Centre Hospitalier Universitaire de Nantes, Nantes, France; on behalf of the Association Recommandations En Dermatologie (aRED), Société Française de Dermatologie 
b Dermatology Department, Centre Hospitalier Universitaire d’Angers, Angers, France; on behalf of the Association Recommandations En Dermatologie (aRED), Société Française de Dermatologie 

Reprint requests: Morgane Vourc’h-Jourdain, MD, Clinique Dermatologique Centre Hospitalier Universitaire de Nantes, Place Alexis Ricordeau, 44000 Nantes, France.
Abstract
Background

Large congenital melanocytic nevi (LCMN) are defined as congenital melanocytic nevi having a projected adult size exceeding 20 cm in diameter. They occur in 1 in 20,000 to 1 in 500,000 newborns. Therapeutic management of LCMN remains controversial and is often decided according to melanoma risk.

Objective

We sought to synthesize all data available on LCMN-associated melanoma risk, therapeutic assessment, and psychosocial and aesthetic impacts.

Methods

A MEDLINE search was conducted (1966-February 2011), and 22 French- and English-language databases were consulted. Case reports and reviews were excluded, as were studies with fewer than 20 patients and insufficient information about the nevi. Studies were qualitatively assessed and analyzed according to predefined criteria.

Results

Fourteen studies were selected (956 references). A total of 52 (2%) melanomas (2 in 1 patient) developed in 2578 patients. Age at diagnosis ranged from birth to 58 (mean 12.6) years. Primary melanomas were mostly cutaneous (82%) and 68% were located on the trunk; 7 melanomas were visceral. Melanoma-associated LCMN size exceeded 40 cm for 74% and 94% had satellite nevi. Of melanomas, 55% were fatal, with age at death ranging from 0.9 to 40 (mean 10) years. Eighteen patients were still alive with a mean follow-up of 10.2 years. Melanoma incidence assessable for 216 cases was estimated at 2.3 per 1000 patient-years. Behavioral/emotional problems independent of the lesion were common in children.

Limitations

Selected studies were heterogeneous.

Conclusion

LCMN management should be individualized with respect to melanoma risk, and aesthetic and psychosocial aspects.

The full text of this article is available in PDF format.

Key words : congenital melanocytic nevi, melanoma, nevi/psychosocial, nevi/surgery, nevi/therapeutic, systematic review



 Supported by aRED.
 Conflicts of interest: None declared.



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