Pigmented spots (nevi) are normal to human skin. They are part of the aging process. They are not common in children. Occasionally congenital pigmented nevi, while not common, are important to note because they are considered to have a small chance of malignant degeneration. Nevi can vary greatly in size. Small nevi can be removed by any qualified plastic surgeon. Giant congenital pigmented nevi are (fortunately) uncommon. These lesions pose a demanding reconstructive challenge and should be treated by experienced pediatric plastic surgeons.
Treatment protocols for larger nevi vary depending upon the surgeon. This may lead to confusion for parents as to the number of steps required. Common methods include: (1) serial excision; (2) tissue expansion using inflatable balloons beneath adjacent normal skin; (3) direct replacement with grafts; and (4) two-stage replacement with full thickness grafts and Integra® dermal matrix. The philosophy at SSM Cardinal Glennon Children’s Hospital involves early excision of the lesion using the minimum number of surgical interventions and striving for minimal patterns of scarring and color mismatch. If you have further questions, please email Debbie, our nurse coordinator, at firstname.lastname@example.org.