A Case of Congenital Giant Nevus with Generalized Small Congenital

Nevus Treated with Facial Laser

Aiai Xia, Chaohui Li

, Lan Ge and Liangjin Cheng

Department of Dermatology, First Affiliated Hospital of Army Military Medical University, Chongqing, 400038, China

Keywords:

Congenital Giant Nevus, Pancytopenia Congenita, Laser Treatment.

Abstract: The patient was a 16-year-old male with black spots on the trunk, extremities and face for 16 years.

Dermatologic examination: a large number of black macules ranging from corn to green bean in size,

scattered on the face and neck; a whole black macule on the trunk with an area of more than 1,000 cm2,

which is rare, with a markedly thickened surface, papillae and folds; a black macule of soybean to bean size

on the extremities. Diagnosis: congenital giant nevus with pancystic congenital nevus. Combined with the

combination of factors in this patient, laser treatment of her facial lesions was considered with good results.

1 INTRODUCTION

Congenital melanocytic nevi are defined as

congenital pigmented nevi >20 cm in diameter in

adulthood, and according to the Ruiz-Maldonao

(Ruiz-Maldonao, 2004) classification, congenital

melanocytic nevi (CMN) >20 cm in diameter are

referred to as GCMN, which are subdivided into

three categories, with G1 measuring 21-30 cm in

diameter, G2 measuring 31-40 cm in diameter and

G3 measuring >40 cm in diameter. If there are more

than 50 satellite foci, the classification is increased

by one level from the above. Congenital

macromegaly is a relatively rare skin tumour with

an incidence of approximately 1 in 20,000

(Vourc'h-Jourdain, 2013) but has a certain risk of

malignancy and significant cosmetic abnormalities.

The disease often affects the appearance of the skin

and places a huge psychological and psychiatric

burden on patients and their families. The disease is

currently treated surgically with various surgical

procedures including free skin grafts, fractionated

excision, direct excision + flap transfer repair, and

skin soft tissue expansion (Saida, 2006; Ibrahimi,

2012; Nacarelli, 2014; Zhan, 2016). Some studies

have also used ultra-pulsed CO2 fractional laser to

treat giant nevi (Fu, 2019), but some of them

showed scarring. Eggen et al. found that exfoliative

lasers were most commonly used in giant or large

nevi, but were prone to scarring. Q-switched lasers

combined with CO2 lasers showed low incidence of

hyperpigmentation and scarring and good cosmetic

improvement (Eggen, 2018). Funayama et al. treated

children with a combination of PDL fuel laser +

Q-switched laser, which showed a significant

reduction in the number of melanocytes and in the

incidence of scarring compared to post-excisional

skin implants (Funayama, 2012). In the present case,

the facial lesions were treated with a sequential

treatment of multiple lasers of CO2 laser, 585 dye

laser and CO2 fractional laser with remarkable

efficacy as reported below.

2 MEDICAL RECORD

INFORMATION

The patient is a 16-year-old male who presented to

our department with a 16-year history of black spots

on the trunk, extremities and face. The patient had no

apparent cause for the gradual appearance of black

spots on the face, trunk and extremities, which

increased over the years and have since spread all

over the body. On the face and neck, a large number

of black spots ranging in size from corn to green

beans were seen in a scattered pattern; on the trunk, a

whole black rash, >40 cm in diameter, with a

markedly thickened surface, papillae and folds; on

the extremities, a black rash the size of a soybean to

a bean was seen. The rash is not seasonal or sunlight

dependent, and there is no family history of similar

disease. Growth and mental development are normal.

Xia, A., Li, C., Ge, L. and Cheng, L.

A Case of Congenital Giant Nevus with Generalized Small Congenital Nevus Treated with Facial Laser.

DOI: 10.5220/0012015500003633

In Proceedings of the 4th International Conference on Biotechnology and Biomedicine (ICBB 2022), pages 167-170

ISBN: 978-989-758-637-8

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

167

Physical examination: good general condition,

normal development, responsive, clear, cooperative,

no trauma or deformity of the skull, normal eye

distance, normal eye shape, no yellowing or spotting

of the sclera bilaterally, normal hearing in both ears,

clear respiratory sounds, no murmur in the

auscultation area of the heart valves, no subcostal

palpation of the liver and spleen, no abnormality of

the external genitalia or anus, no deformity of the

spine of the limbs, no pathological reflexes elicited,

no abnormality of other systems. No other systemic

abnormalities were noted. The clinical diagnosis is:

congenital macro nevus with generalized congenital

micro nevus. The patient requested laser treatment of

the facial lesions and was advised of the possibility

of malignant transformation.

Figure 1: Clinical photographs 1A: preoperative face; 1B: abdomen; 1C: back; 1D: lower leg; 1E: arm.

3 LASER TREATMENT

The patient requested laser treatment for facial

lesions, and the first treatment was with a carbon

dioxide laser (Chongqing Jinyu), wavelength

10600nm, treatment parameters: energy 15mJ,

frequency 15HZ, pulse width 2ms. 2% lidocaine

local infiltration anesthesia for 1 hour before the

start of treatment, after cleaning, the lesions were

first disinfected with 75% alcohol, then 0.9% saline

wiped, the laser continuously and evenly swept the

lesions The lesion is then repeatedly scrubbed with a

0.9% saline swab to remove the carbonised tissue,

then continuous sweeping plus wiping, followed by

intermittent firing pattern plus repeated wiping

when there is less melanin, until the black tissue is

invisible to the naked eye. The patient is instructed

not to touch the lesions with water for 10-15 days

and not to scratch the lesions, the scabs are left to

peel off on their own and the combination of

recombinant bovine basic epidermal growth factor

gel is applied topically once daily after surgery. The

second treatment was performed with a 585 dye

laser (cynosure, USA) to treat scattered erythema

and scarring on the face with the following

parameters The second treatment was performed

with a 585 dye laser (cynosure, USA) with the

following parameters: PDL 7.5 J/cm

, pulse width

0.5 ms, spot 7 mm. 1 month after the second

treatment, the third treatment was performed. The

third treatment was performed with a CO

fractional

laser (Wuhan Hi-Tech Hengda) on the scar,

treatment parameters: scanning area 7mm×7mm,

fractional energy 39mJ. Postoperative combination

with recombinant bovine basic fibroblast growth

factor gel was applied topically once daily. After the

3rd treatment the facial lesions were significantly

improved and the patient was very satisfied with the

results, and the patient did not undergo further laser

treatment at a later stage. See Figure 2.

ICBB 2022 - International Conference on Biotechnology and Biomedicine

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Figure 2: 2A: preoperative face; 2B: after 1st treatment with CO

laser; 2C: after 2nd treatment with 585 dye laser; 2D: after

3rd treatment with CO

fractional laser.

4 DISCUSSION

Surgery is currently the main treatment for

congenital nevus, including free skin grafting,

fractional excision, direct excision + flap transfer

repair, and soft tissue expansion (Saida, 2006;

Ibrahimi, 2012; Nacarelli, 2014; Zhan, 2016).

However, in this case, the lesion was particularly

large, with a diameter of 80 cm and an area of more

than 1,000 cm

, which was already in the G4 class,

so neither flap grafting nor fractionated excision was

appropriate, and the site of the giant nevus was

located at the trunk, so there was little therapeutic

significance and no treatment was done for the time

being. Although the treatment of congenital giant

nevus panchromatic congenital nevus is not

particularly satisfactory, it is often accompanied by

a heavy psychological burden and a severe lack of

self-confidence if the patient has severe skin lesions

in exposed areas, especially on the face (Wan,

2020). Therefore, the facial lesions of the disease

have some therapeutic implications. Treatment

options vary from patient to patient, taking into

account cosmetic, psychosocial and functional

factors (Li, 2020). In some cases, the facial lesions

are large flaps, and significant results have been

reported with flap plasty and skin expansion (Ye,

2014; Zhang, 2017). The treatment of congenital

nevi should be individualized and comprehensive,

taking into account the patient's age, the location

and size of the lesion, the presence of a large

number of small nevi around the nevus, the risk of

secondary melanoma, the expected outcome of the

surgery, the postoperative complications and

psychological guidance. Long-term follow-up is

also required to prevent recurrence and malignancy.

In this case, the facial lesions were heavily

granular, so laser treatment was considered, starting

with carbon dioxide laser treatment, but the melanin

was deep and it was difficult to avoid superficial

scar formation after carbon dioxide laser treatment

(Zhu, 2016), so sequential treatment of the later scar

was very important. There are various scar treatment

modalities, and dye laser and fractional laser have

some synergistic effects in the treatment of scarring,

especially in the inflammatory scarring phase where

PDL with dye laser is very effective (R. Rox

Anderson, 2014). 585 dye laser is used early after

the scab has fallen off to reduce the late scar shape,

and further CO2 fractional laser is used later to

improve the scar and promote healing (Tan, 2017).

Further repair after laser surgery combined with

recombinant bovine basic fibroblast growth factor

gel has been effective in preventing and improving

scarring (Zhang, 2021).

5 CONCLUSION

In summary, although there have been many reports

of congenital macromegaly, it is still rare to find a

macromegaly with severe lesions at the G4 level,

and even rarer to have a generalized nevus. Laser

treatment of the large number of scattered lesions on

the face has also been less frequently reported. In

order to increase the patient's self-confidence and

improve the quality of life, treatment of congenital

giant nevus with congenital small nevi is necessary.

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