Functional Subunit Reconstruction of Giant Facial Congenital Melanocytic Nevi in Children With the Use of Matriderm and Skin Graft

Surgical Experience and Literature Review

Nehal Mahabbat, MBBS; Nawaf Alohaideb, MBBS; Faris Aldaghri, MBBS; Feras Alshomer, MBBS, MSc; Mohamed Amir Murad, MBBS, FRCSC

Disclosures

ePlasty. 2018;18(e30) 

In This Article

Abstract and Introduction

Abstract

Introduction: Facial giant congenital melanocytic nevus represents a major cosmetic deformity for the child and parents and is a challenge for the plastic surgeons to achieve best cosmetic results. Herein, we present a case of single-stage surgical reconstruction using partial-thickness scalp skin graft aided with Matriderm dermal substitute for a facial giant congenital melanocytic nevus.

Methods: An 8-year-old boy presented with a facial giant congenital melanocytic nevus without leptomeningeal involvement. A single-stage complete excision of the nevus was performed. A split-thickness skin graft, 12/1000-inch thick, was then harvested from the anterior scalp region for reconstruction. A 1-mm Matriderm dermal substitute was first applied, on which functional subunit skin graft was then secured to cover the defect. Eyelid reconstruction was reconstructed separately using full-thickness postauricular skin grafts.

Results: Histopathology of the excised specimen confirmed the diagnosis of congenital melanocytic nevus, with no evidence of melanoma. The donor area healed with a favorable scar and no donor site morbidity or complications such as alopecia or hypertrophic scar. The postoperative result was satisfactory with minimal residual nevus around the eye, and the patient was fully satisfied with the cosmetic and functional results.

Discussion and Conclusions: Resection of facial congenital melanocytic nevi, followed by single-stage reconstruction using Matriderm and skin graft from the scalp, is an excellent and fast reconstructive method with promising aesthetic outcomes and greater improvement in physiological outcome, especially in the pediatric population.

Introduction

Giant congenital melanocytic nevus (GCMN) is defined as a congenital melanocytic lesion involving more than 2% body surface area in infants and toddlers or a diameter of more than 20 cm in adults.[1,2] Approximately 1 in 20,000 people are born with a large congenital melanocytic nevus (CMN) and 1 in 500,000 are born with a very large (giant) CMN,[3–5] with a higher potential risk of malignant transformation during the first 20 years of life.[6] Giant nevi on the scalp and neck might be associated with neurological disorders such as focal neurological abnormalities, neurofibromatosis, or epilepsy, known as leptomeningeal melanocytosis. Neuroimaging studies are recommended for such patients to detect associated disorders that could affect treatment and prognosis.[7] A lesion on the face represents a major cosmetic deformity for the child and parents and is a challenge for the plastic surgeons to achieve best cosmetic results. Moreover, not all giant congenital nevi are pigmented, resulting in confusion about the management approach and follow-up. In total, 70% of melanomas are diagnosed by the age of 10 years.[7,8] The relative risk of developing melanoma within a GCMN varies among types from 5% to 10% over one's lifetime.[9] Hence, early prophylactic excision and reconstruction are advisable.[10,11]

The goal of treatment is complete excision with satisfactory cosmetic reconstruction. Therefore, during treatment decision, factors such as psychological effect and the risk of surgery and malignant transformation should be considered.[12]

We report here a case of a patient who underwent single-stage lesion resection and functional subunit reconstruction with the use of Matriderm acellular dermal matrix and partial-thickness skin graft harvested from the scalp, with acceptable functional and aesthetic results.

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