Congenital Nevi: Questions About Irregular Shapes and Treatment Options

Questions about congenital melanocytic nevi?

Dear Dr.
Wu,
Hello.
I have a congenital melanocytic nevus on the upper right side of my back.
It has been present for nearly forty years, and with age, it has slightly increased in size and thickness, but it is not painful or itchy.
What confuses me is that its shape has been irregular since childhood; if I had to describe it, it resembles the shape of "Hainan Island." Surrounding it are 3 to 4 small brownish spots, which are slightly aligned, with the central color being a deeper black and the surrounding areas being lighter black or brown.

I would like to ask Dr.
Wu the following questions:
Q1.
Is it necessary for a congenital melanocytic nevus to be symmetrical and round to be considered normal? Or are irregular or asymmetrical shapes of congenital melanocytic nevi also normal (or common)?
Q2.
My congenital melanocytic nevus, which I refer to as "Hainan Island," is approximately 1 cm in size.
The surrounding 3 to 4 brownish spots are very small, measuring about 0.1 to 0.2 cm.
If I wish to seek medical treatment to remove the nevus, I plan to first use laser treatment to remove the small brown spots, and then consider surgical excision for the larger "Hainan Island" nevus, which is slightly raised.
Is this approach advisable, or should all the spots, regardless of size, be surgically excised?
Thank you for your guidance, Dr.
Wu.

Axiang, 40~49 year old female. Ask Date: 2023/09/28

Dr. Wu Yuxin reply Dermatology

The shape and size are not absolute considerations for determining the presence of lesions; pathological slides are essential for that.
Whether to proceed with excision or laser treatment requires a face-to-face discussion, and I cannot make that decision for you here.

Reply Date: 2023/09/28

More Info

When it comes to congenital nevi, or congenital melanocytic nevi, there are several important considerations regarding their appearance, potential risks, and treatment options. Your questions touch on some critical aspects of understanding these skin lesions, particularly concerning their irregular shapes and the appropriate management strategies.

Q1: Is it normal for congenital nevi to be irregular or asymmetrical?
Congenital nevi can indeed present in various shapes and sizes, and they do not necessarily have to be symmetrical or round to be considered normal. While many congenital nevi are round or oval, irregular shapes are not uncommon. The key factor is the stability of the lesion over time. If a congenital nevus remains stable in size and color without any significant changes, it is generally considered benign. However, any changes in size, shape, color, or texture should be evaluated by a dermatologist, as these could indicate potential complications, including the risk of melanoma, particularly in larger nevi.

Q2: Regarding treatment options for your congenital nevus and surrounding spots:
In your case, where you have a larger congenital nevus described as resembling "Hainan Island" and several smaller café-au-lait spots, there are a few treatment options to consider. Laser treatment can be effective for smaller pigmented lesions, such as the café-au-lait spots you mentioned. Laser therapy can help lighten these spots without the need for surgical excision, which is often more invasive and carries a higher risk of scarring.

For the larger congenital nevus, especially since you noted it has slightly elevated areas, surgical excision may be the most appropriate option. Surgical removal allows for a thorough evaluation of the nevus and ensures that any atypical cells are removed. It is essential to have a dermatologist or a plastic surgeon evaluate the nevus to determine the best approach for excision, considering factors such as its size, location, and any associated symptoms.

In summary, while irregular shapes in congenital nevi can be normal, any changes should be monitored closely. For treatment, laser therapy may be suitable for smaller spots, while surgical excision is often recommended for larger nevi, especially if they show any signs of change. Consulting with a dermatologist who specializes in pigmented lesions will provide you with the best guidance tailored to your specific situation.

Additional Considerations:
- Monitoring: Regular follow-ups with a dermatologist are crucial, especially for congenital nevi, to monitor any changes over time. This is particularly important if you have a family history of skin cancer or if there are any concerning changes in the nevus.

- Surgical Risks: If you opt for surgical excision, be aware of potential risks such as scarring, infection, and changes in pigmentation. Discuss these risks with your surgeon beforehand.

- Psychological Impact: The presence of congenital nevi can sometimes affect self-esteem and body image. If you find that your nevus impacts your confidence, discussing cosmetic options with a dermatologist can be beneficial.

In conclusion, congenital nevi can vary significantly in appearance, and while irregular shapes can be normal, any changes should be evaluated. Treatment options include laser therapy for smaller spots and surgical excision for larger nevi. Regular monitoring and consultation with a specialist are key to ensuring the best outcomes for your skin health.

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