Giant Congenital Melanocytic NaevusCorrespondence Address :
Dr. K. Shreedhara Avabratha,Asso. Prof.,
Dept. of Pediatrics,Fr. Muller Medical College,
Kankanady, Mangalore-575002,Karnataka, India.
Ph:(0824)2238000,09448027147.E mail: firstname.lastname@example.org
Term female baby born by normal vaginal delivery to a second gravida mother with uneventful antenatal history was noted to have large hyper pigmented patches over the anterior abdomen, back and proximal parts of both thighs covering up to 30% of body surface area. Diameter of the largest naevus was 25 cm in its long axis (Table/Fig 1). Many satellite lesions were also found scattered over the body (Table/Fig 2). All lesions were blackish in colour and were well defined. Though most lesions had a smooth surface, few over the back were noted to have a rough surface with hairy outgrowths.
Congenital pigmented naevi have been arbitrarily divided into 3 size ranges depending on their maximum diameter as small, being less than 1.5 cm, medium, being 1.5-20cm and large or giant, being over 20cm 1, 2. The incidence ranges from 1in 20,000 to 1in 50,00003. Other synonyms for a giant congenital naevus (GCMN) are bathing trunk naevus or garment type naevus. GCMN is extremely rare, occurring one in 500,000 newborns4. Giant congenital naevi carry the potential for malignant change. The risk is well documented in lesions involving over 5 percent of the body surface5. Large axial lesions with many satellite lesions may be associated with neurocutaneous melanosis which may be detected by the brain MRI scan6.
This type of giant garment or bathing trunk naevi is very distressing to the parents and poses a difficult surgical challenge. Many centers recommend deep curettage or shaving in the early neonatal period, with the objective of removing as many melanocytic naevus cells as possible7. Autologous grafts are then used for resurfacing. Alternative approaches of treatment are dermabrasion, laser therapy and curettage, but carry a greater risk of leaving behind naevus cells. Regardless of the method of choice, lifelong periodic cutaneous examination is indicated, especially in those lesions which are not excised6.
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