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01-04-2020 | Nevi | Original Article

Surgical treatment of children and youth with congenital melanocytic nevi: self- and proxy-reported opinions

Authors: Kathrin Neuhaus, Markus Landolt, Miliana Vojvodic, Sophie Böttcher-Haberzeth, Clemens Schiestl, Martin Meuli, Ornella Masnari

Published in: Pediatric Surgery International | Issue 4/2020

Abstract

Purpose

The role of surgery in the management of congenital melanocytic nevi (CMN) is controversial. Data on surgical outcomes and predictors of satisfaction remain scarce.

Methods

An online survey was employed following worldwide recruitment of youth aged 14–25 years (n = 44) and parents of children ≤ 18 years (n = 249) with CMN to query patterns of treatment and satisfaction with and opinions about the benefits of surgery.

Results

In proxy-reports, 121 of 249 (49%) and in self-reports 30 of 44 (75%) participants underwent CMN excision. The most common reasons for surgery were psychosocial determinants, aesthetic improvement, and melanoma risk reduction. The overall satisfaction with surgical management was good, although no predictors for satisfaction could be identified. Higher current age of the child was found to predict decision regret in proxy-reports. Most participants indicated that having a scar is more socially acceptable than a CMN. Opinions differed on whether surgery should be deferred until the child is old enough to be involved in the decision-making process.

Conclusions

Whether and when to perform surgery in children with CMN is a multifaceted question. Awareness of common concerns as well as risks and benefits of surgery are essential to ensure critical reflection and balanced decision-making.

Alikhan A, Ibrahimi OA, Eisen DB (2012) Congenital melanocytic nevi: where are we now?: Part I. Clinical presentation, epidemiology, pathogenesis, histology, malignant transformation, and neurocutaneous melanosis. J Am Acad Dermatol 67(4):495.e1–495.e17. https://doi.org/10.1016/j.jaad.2012.06.023 CrossRef

Castilla EE, Dutra M, Orioli-Parreiras IM (1981) Epidemiology of congenital pigmented naevi: I. Incidence rates and relative frequencies. Br J Dermatol 104(3):307–315. https://doi.org/10.1111/j.1365-2133.1981.tb00954.x CrossRefPubMed

Price HN, Schaffer JV (2010) Congenital melanocytic nevi—when to worry and how to treat: facts and controversies. Clin Dermatol 28(3):293–302. https://doi.org/10.1016/j.clindermatol.2010.04.004 CrossRefPubMed

Kinsler VA, Birley J, Atherton DJ (2009) Great Ormond Street Hospital for children registry for congenital melanocytic naevi: prospective study 1988–2007. Part 2—evaluation of treatments. Br J Dermatol 160(2):387–392. https://doi.org/10.1111/j.1365-2133.2008.08901.x CrossRefPubMed

Walton RG, Jacobs AH, Cox AJ (1976) Pigmented lesions in newborn infants. Br J Dermatol 95(4):389–396. https://doi.org/10.1111/j.1365-2133.1976.tb00840.x CrossRefPubMed

Lovett A, Maari C, Decarie JC et al (2009) Large congenital melanocytic nevi and neurocutaneous melanocytosis: one pediatric center’s experience. J Am Acad Dermatol 61(5):766–774. https://doi.org/10.1016/j.jaad.2008.11.022 CrossRefPubMed

Zaal LH, Mooi WJ, Sillevis Smitt JH, van der Horst CMAM (2004) Classification of congenital melanocytic naevi and malignant transformation: a review of the literature. Br J Plast Surg 57(8):707–719. https://doi.org/10.1016/j.bjps.2004.04.022 CrossRefPubMed

Kinsler VA, O’Hare P, Bulstrode N et al (2017) Melanoma in congenital melanocytic naevi. Br J Dermatol 176(5):1131–1143. https://doi.org/10.1111/bjd.15301 CrossRefPubMedPubMedCentral

Arad E, Zuker RM (2014) The shifting paradigm in the management of giant congenital melanocytic nevi: review and clinical applications. Plast Reconstr Surg 133(2):367–376. https://doi.org/10.1097/01.prs.0000436852.32527.8a CrossRefPubMed

10.

Kinsler V, Bulstrode N (2009) The role of surgery in the management of congenital melanocytic naevi in children: a perspective from Great Ormond Street Hospital. J Plast Reconstr Aesthetic Surg 62(5):595–601. https://doi.org/10.1016/j.bjps.2008.12.016 CrossRef

11.

Schaffer JV (2015) Update on melanocytic nevi in children. Clin Dermatol 33(3):368–386. https://doi.org/10.1016/j.clindermatol.2014.12.015 CrossRefPubMed

12.

Krengel S, Marghoob AA (2012) Current management approaches for congenital melanocytic nevi. Dermatol Clin 30(3):377–387CrossRef

13.

Hassanein AH, Rogers GF, Greene AK (2015) Management of challenging congenital melanocytic nevi: outcomes study of serial excision. J Pediatr Surg 50(4):613–616. https://doi.org/10.1016/j.jpedsurg.2014.08.020 CrossRefPubMed

14.

Schiestl C, Stiefel D, Meuli M (2010) Giant naevus, giant excision, eleg(i)ant closure? Reconstructive surgery with Integra Artificial Skin^® to treat giant congenital melanocytic naevi in children. J Plast Reconstr Aesthetic Surg 63:610–615CrossRef

15.

Bauer BS, Corcoran J (2005) Treatment of large and giant nevi. Clin Plast Surg. https://doi.org/10.1016/j.cps.2004.08.004 CrossRefPubMed

16.

Zaal LH, van der Horst CM (2009) Results of the early use of tissue expansion for giant congenital melanocytic naevi on the scalp and face. J Plast Reconstr Aesthetic Surg 62(2):216–220. https://doi.org/10.1016/j.bjps.2007.10.045 CrossRef

17.

Lim JM, Oh Y, Lee SH, Cho MY, Chung KY, Roh MR (2019) Comparison of treatment options for small to medium congenital melanocytic nevi: a retrospective review of 119 cases. Lasers Surg Med. https://doi.org/10.1002/lsm.23030 CrossRefPubMed

18.

Ott H, Krengel S, Beck O et al (2019) Multidisciplinary long-term care and modern surgical treatment of congenital melanocytic nevi—recommendations by the CMN surgery network. J Dtsch Dermatol Ges 17(10):1005–1017. https://doi.org/10.1111/ddg.13951_g CrossRefPubMed

19.

Masnari O, Neuhaus K, Aegerter T, Reynolds S, Schiestl CM, Landolt MA (2019) Predictors of health-related quality of life and psychological adjustment in children and adolescents with congenital melanocytic nevi: analysis of parent reports. J Pediatr Psychol 44(6):714–725. https://doi.org/10.1093/jpepsy/jsz007 CrossRefPubMed

20.

Neuhaus K, Landolt MA, Theiler M, Schiestl C, Masnari O (2019) Skin-related quality of life in children and adolescents with congenital melanocytic nevi—analysis of self- and parent reports. J Eur Acad Dermatol Venereol. https://doi.org/10.1111/jdv.16131 CrossRefPubMed

21.

Goodman E, Adler NE, Kawachi I et al (2001) Adolescents’ perceptions of social status: development and evaluation of a new indicator. Pediatrics 108(2):1–8. https://doi.org/10.1542/peds.108.2.e31 CrossRef

22.

Draaijers LJ, Tempelman FRH, Botman YAM et al (2004) The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg 113(7):1960–1965. https://doi.org/10.1097/01.PRS.0000122207.28773.56 CrossRefPubMed

23.

Vercelli S, Ferriero G, Sartorio F, Stissi V, Franchignoni F (2009) How to assess postsurgical scars: a review of outcome measures. Disabil Rehabil. https://doi.org/10.3109/09638280902874196a CrossRefPubMed

24.

Van De Kar AL, Corion LUM, Smeulders MJC, Draaijers LJ, Van Der Horst CMAM, Van Zuijlen PPM (2005) Reliable and feasible evaluation of linear scars by the patient and observer scar assessment scale. Plast Reconstr Surg 116(2):514–522. https://doi.org/10.1097/01.prs.0000172982.43599.d6 CrossRefPubMed

25.

Cohen J (1988) Statistical power analysis for the behavioural sciences, vol 66. Lawrence Erlbaum Associates, New York

26.

Krengel S, Reyes-Múgica M (2017) Melanoma risk in congenital melanocytic naevi. Br J Dermatol 176(5):1114CrossRef

27.

Koot HM, De Waard-Van Der Spek F, Peer CD, Mulder PGH, Oranje AP (2000) Psychosocial sequelae in 29 children with giant congenital melanocytic naevi. Clin Exp Dermatol. 25:589–593CrossRef

28.

Olsen JR, Gallacher J, Finlay AY, Piguet V, Francis NA (2016) Quality of life impact of childhood skin conditions measured using the Children’s Dermatology Life Quality Index (CDLQI): a meta-analysis. Br J Dermatol 174(4):853–861. https://doi.org/10.1111/bjd.14361 CrossRefPubMed

29.

Wramp ME, Langenbruch A, Augustin M, Zillikens D (2017) Clinical course, treatment modalities, and quality of life in patients with congenital melanocytic nevi—data from the German CMN registry. J Dtsch Dermatol Ges 15(2):159–167. https://doi.org/10.1111/ddg.12835 CrossRef

30.

Rumsey N, Harcourt D (2007) Visible difference amongst children and adolescents: issues and interventions. Dev Neurorehabil 10(2):113–123. https://doi.org/10.1080/13638490701217396 CrossRefPubMed

31.

Krengel S, Hauschild A, Schafer T (2006) Melanoma risk in congenital melanocytic naevi: a systematic review. Br J Dermatol 155(1):1–8. https://doi.org/10.1111/j.1365-2133.2006.07218.x CrossRefPubMed

32.

Mosa A, Ho ES, Heinelt M, Karen BAS, Neuhaus K (2019) Management of congenital melanocytic nevi in the plastic surgery clinic: families’ expectations and their persistent concern about malignancy. Pediatr Dermatol. https://doi.org/10.1111/pde.13987 CrossRefPubMed

33.

Slutsky JB, Barr JM, Femia AN, Marghoob AA (2010) Large congenital melanocytic nevi: associated risks and management considerations. Semin Cutan Med Surg 29(2):79–84. https://doi.org/10.1016/j.sder.2010.04.007 CrossRefPubMed

34.

Bhananker SM, Ramamoorthy C, Geiduschek JM et al (2007) Anesthesia-related cardiac arrest in children: update from the pediatric perioperative cardiac arrest registry. Anesth Analg. https://doi.org/10.1213/01.ane.0000268712.00756.dd CrossRefPubMed

35.

Loepke AW, Soriano SG (2008) An assessment of the effects of general anesthetics on developing brain structure and neurocognitive function. Anesth Analg 106(6):1681–1707. https://doi.org/10.1213/ane.0b013e318167ad77 CrossRefPubMed

36.

Mellon RD, Simone AF, Rappaport BA (2007) Use of anesthetic agents in neonates and young children. Anesth Analg 104(3):509–520. https://doi.org/10.1213/01.ane.0000255729.96438.b0 CrossRefPubMed

37.

Fujiwara M, Nakamura YFH (2008) Treatment of giant congenital nevus of the back by convergent serial excision. J Dermatol 35(9):608–610. https://doi.org/10.1111/j.1346-8138.2008.00534.x CrossRefPubMed

38.

Berg P, Lindelöf B (2003) Congenital melanocytic naevi and cutaneous melanoma. Melanoma Res 13(5):441–445CrossRef

Title: Surgical treatment of children and youth with congenital melanocytic nevi: self- and proxy-reported opinions
Authors: Kathrin Neuhaus
Markus Landolt
Miliana Vojvodic
Sophie Böttcher-Haberzeth
Clemens Schiestl
Martin Meuli
Ornella Masnari
Publication date: 01-04-2020
Publisher: Springer Berlin Heidelberg
Keywords: Nevi
Melanoma
Melanoma
Published in: Pediatric Surgery International / Issue 4/2020
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-020-04633-z

At a glance: The STEP trials

Springer Medicine

Surgical treatment of children and youth with congenital melanocytic nevi: self- and proxy-reported opinions

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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