How Do We Treat Giant Congenital Nevi?
If the nevus is small enough, it can be removed in stages, usually through surgeries. Sometimes the child’s skin can be closed over the nevus surgically, but in cases where the nevus is very large, a child’s skin can be grown to replace the nevus.
Tissue expansion often provides the best outcomes in terms of appearance and function for patients with giant congenital nevi. Tissue expansion is a common effective way of developing more skin or tissue to cover the area from which the nevus will be removed. In this procedure, the skin and soft tissues near the giant nevus are stretched to grow new skin. If tissue expansion is performed, a balloon — called an expander — is placed under the child’s skin, typically near the nevus so that a flap of skin can be created. Over a period of one to three months, the expander is filled with more and more liquid to gradually stretch the skin around it. When enough extra skin has been created, the tissue expansion is complete, and the new flap of skin is used to replace the nearby nevus.
By using a child’s own skin to reconstruct the location of a nevus, this tissue expansion often provides new skin with nearly matching color, texture and other qualities of the rest of the child’s skin.
Tissue expansion can be done practically anywhere on the body, and the child’s doctor will determine the best area for the expander balloon to be placed. Some common areas for tissue expansion are in the thigh, back, abdomen and scalp. Many patients report being able to maintain their routine and activities with the expanders in place.
Skin Grafts & Alternative Methods
There are ways other than tissue expansion to resurface the giant nevus. Some of these include skin grafts taken from an area not near the nevus, flaps of tissue transferred from nearby areas or microvascular transfer of skin and tissues from other parts of the body. However, these techniques are often compromised in their ability to match the skin to be replaced, particularly in the face. This is an advantage of tissue expansion, since it relies on stretching the skin adjacent to the nevus, which is the best match for the replacement skin.
There may also be nonsurgical treatments appropriate for the child, including high intensity exfoliating techniques (dermabrasion), chemical peels and laser removal. However, these techniques only impact the appearance of the nevus, and do not decrease the risk of skin cancer arising from the giant nevus.
Removing the nevus often requires multiple stages and sometimes different types of procedures. The best treatment options for a child depend on the location of the nevus, the child’s age, medical history and other variables.
Lurie Children’s staff will help educate families about the benefits and risks of each procedure and why it may be appropriate for the child. When necessary, staff will also help families understand how to properly care for a child’s wound and scar from the surgical site after they go home.
A doctor will discuss all the possible options to determine which method will be the best and most comfortable for the child, who is likely to experience improved appearance and a decreased risk of complications from the nevi.
At Lurie Children’s, physicians, nurses, a social worker and a family life specialist will work with families to prepare a comprehensive plan for the child and then ensure the plan is carried through.