The senior author (RM Zuker) presents a discussion with evidence, on the controversies and shift in the treatment paradigm for giant congenital melanocytic naevi (GCMN). On review of the current literature the overall incidence of melanoma in GCMN is 0.7 to 2.9 %, with the highest incidence limited to lesions >20cm or with multiple satellites. Recent evidence also states that surgical treatment does not reduce the risk of melanoma and early treatment may induce adverse clinical outcomes such as new satellites and new pigmentation. The timing of surgery was also discussed; stating that there is no evidence for early surgery to reduce scarring and may lead to over-excision and subsequent constrictive scarring requiring further surgery. RMZ’s primary indication for surgery is GCMN with high-risk phenotypic features, such as trunk location, satellites and irregular morphology. The second indication is for functional issues relating to the lesion and lastly for aesthetic benefit. Curettage and dermabrasion are now not recommended. This is an extremely informative paper that goes into further detail with aesthetic considerations for different anatomical regions.

The shifting paradigm in the management of giant congenital melanocytic naevi: review and clinical applications.
Arad E, Zuker R.
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Neil J Cahoon

St John's Hospital, Livingston, UK.

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