Nevus Melanocitico Congénito

Published in Dermatology

Journal Scan / Research · September 17, 2019

Management of Congenital Melanocytic Nevi in the Plastic Surgery Clinic

Pediatric Dermatology

TAKE-HOME MESSAGE

• In this study, 30 patients with congenital melanocytic nevi (CMN) who presented to a pediatric plastic surgery clinic completed a pre-visit and a post-visit survey. Concern about malignancy was the top reason for wanting the CMN surgically removed (37%), while only 8% of referring providers, a majority of whom were dermatologists, were concerned about malignancy. After the visit, the percentage of families who were "extremely worried" about cancer decreased from 21% to 3%, but the majority of patients' attitudes towards surgery had not changed (22/30).

• There is discordance between referring providers and patients and their families regarding concern for malignancy in CMN. This could be explained by inadequate communication between referring providers and families or false information in the literature read by patients about melanoma risk.

– Margaret Hammond, MD

Abstract 

BACKGROUND

Children with congenital melanocytic nevi (CMN) were historically managed with surgical removal to lower the risk of malignant transformation. The evolving literature over the last decade has indicated a significantly lower risk than previously estimated. Indications for excision currently revolve around aesthetic and psychosocial concerns. This study describes and evaluates the perspectives and expectations of patients and families referred to a pediatric plastic surgery clinic on CMN management.

METHOD

A two-part questionnaire was administered before and after an initial clinic appointment to evaluate patient and family concerns of lesion growth, risk of malignancy, treatment expectations, and stigmatization.

RESULTS

Thirty questionnaires were completed for 11 male and 19 female patients, mean age 9.2 years (1-25). Referring doctors (majority dermatologists) were rarely concerned about malignancy (8%), but parents listed it as a top reason for wanting the CMN removed (37%) and the most common expectation for the visit followed by information about surgical options and outcome. Before the clinic, 93% were at least "slightly" worried about CMN growth and 96% about malignancy, whereas 63% and 72%, respectively, after the clinic.

CONCLUSIONS

Families want information about surgical excision and are concerned about malignancy, indicating lingering misinformation or misconception about melanoma risk. For the majority, CMN removal remains at least slightly important, presumably for aesthetic reasons and remaining concern about malignancy. Involved health care professionals should assure reliable and coherent patient information about MM risk, indications for surgery and expected outcome to best support families' decision-making.

Pediatric Dermatology

Management of Congenital Melanocytic Nevi in the Plastic Surgery Clinic: Families' Expectations and Their Persistent Concern About Malignancy

Pediatr Dermatol 2019 Aug 29;[EPub Ahead of Print], A Mosa, ES Ho, M Heinelt, K Wong, K Neuhaus 

Sent from my iPhone

Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

Please excuse the shortness of this message, as it has been sent from
a mobile device.