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Treatment

Treatment of congenital nevi depends on size of the lesion, location, perceived risk for melanoma (serious type of skin cancer), and cosmetic outcome.

The lifetime risk for malignant degeneration in a large congenital nevus is approximately 6 percent. In these cases, melanoma can arise in the first few years of life, and excision should be considered as soon as possible. Management is based on the individual and should be determined after consultation with parents and the medical team. When lesions are so extensive as to involve most areas of the skin, excision is not feasible and clinical follow-up is important to detect any early changes.

Laser treatment may lighten areas of the nevus and improve its appearance, but it is not recommended because it doesn't remove the deeper pigment cells where malignant changes occur.

Management of small congenital nevi remains controversial because there is little agreement on their associated potential for malignancy. Nevertheless, most dermatologists believe that small congenital nevi can become malignant, though the percentage is quite low.

Photographs are useful in tracking these nevi, which typically evolve and change as a child grows. In general, small congenital nevi have minimal risk for melanoma before the age of 12. At that time, the risk increases and it becomes more difficult for parents to monitor the lesions. Some doctors advocate following the lesions, and others suggest removing all small congenital nevi. An atypical-looking nevus should be evaluated for excision as soon as possible.

Prognosis

For those who develop melanoma in a large congenital nevus, the prognosis usually is poor. Signs of malignant change include sudden development of a nodule, an ulcer, or itching within the lesion, as well as pain, bleeding, and pigment changes.

Prevention

Congenital nevi, large and small, cannot be prevented. However, malignant changes can be avoided by careful monitoring and, perhaps, prophylactic removal.

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