Clinical effect of full-thickness skin grafts for the treatment of large and giant congenital melanocytic nevus on the face and extremities joints in children

Background: The surgical treatment of large and giant congenital melanocytic nevus (CMN) presents a great challenge. There is no consensus regarding the optimal surgical management. The purpose of this study was to assess the clinical effect of full-thickness skin grafts to repair defects after removal of the large and giant CMN on the face and joints region. Methods: Between March 2012 and July 2015, 20 patients with the large and giant CMN underwent surgical excision of these lesions and closured the defects with full-thickness skin grafts harvested from the lower abdomen. The data on patient demographics, general medical history, excised pathology, graft take, observation of complications and follow-up was analyzed. Results: The mean age was 3.8 years (range, 6 months-9 years). These lesions were located on the face (30%), neck (20%), elbow (20%), hand (15%), knee (5%), foot (10%). The mean area of excised lesions was 136.8 cm2. The mean graft take was 93%, ranging 80% from 100%. 4 patients lost approximately 3%-10% of the graft. Multiple small remaining defects were treated with split-thickness skin graft harvested from thigh. Hypertrophic scarring occurred at the edges of the graft in 3 patients. The mean follow-up time was 1 year (range from 6 months to 2 years). Conclusion: Full-thickness skin grafts is an effective method of repairing the defects resulting from the removal of large and giant nevus on the face, neck, elbow, hand, knee, foot, particularly where there is limited availability of normal adjacent skin for tissue expansion.