Rapid, severe repigmentation of congenital melanocytic naevi after curettage and dermabrasion: histological features
ABSTRACT Curettage and dermabrasion are effective in treating giant congenital melanocytic naevi (GCMN). We report two patients with rapid, severe postoperative repigmentation. To the best of our knowledge this is the first report on the histological features of such patients.
We wish to call attention to histological features that may cause rapid, severe repigmentation after curettage and dermabrasion of medium to giant CMN.
From 1998 to 2002, we treated 23 patients with medium to giant CMN with curettage and dermabrasion. Patients being treated ranged in age from 1 month to 19 years. Histological samples were taken from the centre of naevi in all patients during surgery. Histological types were 12 intradermal and 11 compound. Follow-up after curettage lasted at least 3 years.
Among our 23 patients only two showed repigmentation soon after surgery. Histological sections from these two patients indicated naevoid cells in the deep dermis along hair follicles or sebaceous glands. However, no such pigmented naevoid cells along hair follicles were observed in samples from patients successfully treated with curettage and dermabrasion with less repigmentation.
Although we saw only two cases of repigmentation soon after curettage and dermabrasion, we suspect a correlation between pigmented naevoid cells around hair follicles and repigmentation. If histological sections of skin biopsies show pigmented cells along hair follicles in the deep dermis, other treatments such as total skin resection followed by skin grafting or tissue expansion may be better choices than curettage or dermabrasion.
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ABSTRACT: HintergrundPapillomatöse intradermale Nävi sind häufige, erworbene, melanozytäre Nävi. Obwohl medizinisch unbedenklich, werden sie gerade im Gesichtsbereich oftmals als kosmetisch sehr störend empfunden. An prädisponierten Stellen am Rumpf können sie durch Kleidung traumatisiert werden, sodass häufig Patienten mit dem Wunsch nach einer möglichst rezidiv- und residualfreien Entfernung kommen. Material und MethodenBei 90 (♀=77, ♂=13) Patienten im Alter zwischen 13 und 67Jahren wurde im Rahmen einer Prospektivstudie zur Entfernung von insgesamt 130 papillomatösen intradermalen Nävi (♀=114, ♂=16) eine kombinierte Therapie mittels CO2- sowie Erbium:YAG-Laser und Rubinlaser angewandt. ErgebnisseNach Therapie der papillomatösen intradermalen Nävi ergaben sich 2,3% Pigmentrezidive und 6,9% Höhenrezidive; 88% der Patienten sind mit dem Ergebnis sehr zufrieden, 11% der Patienten sind mit dem Ergebnis zufrieden, 1% der Patienten ist mit dem Ergebnis nicht zufrieden, 99% würden die Therapie wiederholen. SchlussfolgerungDas Kombinationslaserverfahren (CO2-, Erbium:YAG- und Rubinlaser) zur Therapie papillomatöser intradermaler Nävi ermöglicht ansprechende kosmetische Ergebnisse, ist gut praktikabel, ergibt eine hohe Patientenzufriedenheit und ist bei korrekter Anwendung sicher. BackgroundPapillomatous intradermal nevi are common acquired melanocytic nevi. Although harmless, they can be – especially on the face – cosmetically disturbing. At selected sites on the trunk, they may be traumatized by clothing, so that patients often wish to have them removed with a low likelihood of recurrence. Material and methodsIn a prospective study with 90 (♀=77, ♂=13) patients aged between 13 and 67 years, 130 intradermal nevi (♀=114, ♂=16) were removed using a combined therapy with CO2, erbium: YAG and ruby lasers. ResultsAfter therapy, 2.3% of intradermal nevi recurred as a pigmented macule, while 6.9% reappeared as a papule or nodule (volume recurrence). 88% of the patients were very satisfied with the result; 11%, satisfied; and 1%, not satisfied. 99% would undergo the therapy again. ConclusionThe combined laser method (CO2, erbium: YAG and ruby lasers) for the treatment of intradermal nevi produces excellent cosmetic results, is easily performed, leads to high patient satisfaction and is safe if correctly applied.Der Hautarzt 02/2008; 59(2):101-107. DOI:10.1007/s00105-007-1464-0 · 0.54 Impact Factor
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ABSTRACT: Papillomatous intradermal nevi are common acquired melanocytic nevi. Although harmless, they can be - especially on the face - cosmetically disturbing. At selected sites on the trunk, they may be traumatized by clothing, so that patients often wish to have them removed with a low likelihood of recurrence. In a prospective study with 90 (female symbol=77, male symbol=13) patients aged between 13 and 67 years, 130 intradermal nevi (female symbol=114, male symbol=16) were removed using a combined therapy with CO(2), erbium: YAG and ruby lasers. After therapy, 2.3% of intradermal nevi recurred as a pigmented macule, while 6.9% reappeared as a papule or nodule (volume recurrence). 88% of the patients were very satisfied with the result; 11%, satisfied; and 1%, not satisfied. 99% would undergo the therapy again. The combined laser method (CO(2), erbium: YAG and ruby lasers) for the treatment of intradermal nevi produces excellent cosmetic results, is easily performed, leads to high patient satisfaction and is safe if correctly applied.Der Hautarzt 03/2008; 59(2):101-7. · 0.54 Impact Factor
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ABSTRACT: The treatment of congenital melanocytic naevi (CMNs) has become controversial as better data on complications have been published. To determine the longer-term risks and benefits of surgery in treatment of CMNs. In this 19-year prospective study, 301 families completed yearly questionnaires about treatments and CMN changes. Forty per cent of CMNs were > 20 cm projected adult size (PAS) or multiple CMNs. Girls were more likely to have had surgical treatments. There were no significant effects of treatment on the incidence of adverse clinical outcomes, although the numbers for melanoma were small. The majority of untreated CMNs lightened spontaneously during the follow-up period. Surgical treatment and satellites at birth were independently significantly associated with reported darkening of the CMN over the follow-up period. However there was no absolute measurement of final colour. Surgical treatment was associated with decreasing hairiness of the CMN over the follow-up period. PAS was associated with increasing hairiness. Excision with tissue expanders and PAS were significantly associated with an increased incidence of new satellite lesions. A proportion of patients reported new pigmentation in previously unaffected skin at the edge of a treated area, the majority after complete excision. There was a high level of satisfaction with surgery in the < 20 cm group and in those with facial CMNs. This was significantly reduced with increasing PAS. There is no evidence here that surgery reduces the incidence of adverse clinical outcomes in childhood. The natural history of the majority of untreated CMNs is to lighten spontaneously, whereas some treatments may cause adverse effects.British Journal of Dermatology 10/2008; 160(2):387-92. DOI:10.1111/j.1365-2133.2008.08901.x · 4.10 Impact Factor