TY - JOUR
T1 - Safety and effectiveness of surgical excision of medium, large, and giant congenital melanocytic nevi
T2 - A systematic review and meta-analysis
AU - Gout, H. Antoine
AU - Fledderus, Anne C.
AU - Lokhorst, Max M.
AU - Pasmans, Suzanne G.M.A.
AU - Breugem, Corstiaan C.
AU - Lapid, Oren
AU - van der Horst, Chantal M.A.M.
N1 - Publisher Copyright:
© 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons
PY - 2023/2/1
Y1 - 2023/2/1
N2 - Background: Treatment indications of congenital melanocytic naevi (CMN) have shifted from the prevention of malignant transformation more towards the improvement of appearance and psychosocial health. Surgical excision is often preferred, but its safety and effectiveness remain unclear. Objective: To assess the outcomes of surgical excision of medium-to-giant CMN. Primary outcome: safety (complications). Secondary outcome: effectiveness (satisfaction and CMN core outcomes). Methods: PubMed, EMBASE, and CENTRAL were searched for studies on the excision of medium-to-giant CMN and/or CMN requiring reconstruction or serial excision. Meta-analyses of safety per patient were conducted, and pooled outcomes of safety and effectiveness were presented in summary-of-findings tables. Results: A total of 1444 studies were found, of which 22 were included, evaluating 643 eligible patients. Study quality varied, and reporting of baseline characteristics and outcomes was heterogeneous. Pooled proportions were overall 9.8% for major wound-related complications, 1.2% for minor wound-related complications, 1.2% for scar-related complications, and 4.3% for anatomical deformities. For large/giant CMN, complication rates were, respectively, 23.1%, 2.9%, 12.9%, and 2.4%; and for CMN with eyelid involvement, 0.5%, 3.3%, 0.4%, and 54.2%. Patients rated their satisfaction with the cosmetic outcome as 24.4% excellent, 71.0% good, and 4.6% poor/moderate. Physicians rated this as 18.3% excellent, 70.1% good, and 11.7% poor/moderate. Thirty-five other outcomes of effectiveness were summarized. However, many were rarely reported. Conclusions: Surgical excision of CMN appears to be safe and effective in many cases, depending on CMN size and location. Major wound-related complications and scar-related complications occurred more frequently with large/giant CMN, whereas anatomical deformities occurred with the majority of CMN with eyelid involvement.
AB - Background: Treatment indications of congenital melanocytic naevi (CMN) have shifted from the prevention of malignant transformation more towards the improvement of appearance and psychosocial health. Surgical excision is often preferred, but its safety and effectiveness remain unclear. Objective: To assess the outcomes of surgical excision of medium-to-giant CMN. Primary outcome: safety (complications). Secondary outcome: effectiveness (satisfaction and CMN core outcomes). Methods: PubMed, EMBASE, and CENTRAL were searched for studies on the excision of medium-to-giant CMN and/or CMN requiring reconstruction or serial excision. Meta-analyses of safety per patient were conducted, and pooled outcomes of safety and effectiveness were presented in summary-of-findings tables. Results: A total of 1444 studies were found, of which 22 were included, evaluating 643 eligible patients. Study quality varied, and reporting of baseline characteristics and outcomes was heterogeneous. Pooled proportions were overall 9.8% for major wound-related complications, 1.2% for minor wound-related complications, 1.2% for scar-related complications, and 4.3% for anatomical deformities. For large/giant CMN, complication rates were, respectively, 23.1%, 2.9%, 12.9%, and 2.4%; and for CMN with eyelid involvement, 0.5%, 3.3%, 0.4%, and 54.2%. Patients rated their satisfaction with the cosmetic outcome as 24.4% excellent, 71.0% good, and 4.6% poor/moderate. Physicians rated this as 18.3% excellent, 70.1% good, and 11.7% poor/moderate. Thirty-five other outcomes of effectiveness were summarized. However, many were rarely reported. Conclusions: Surgical excision of CMN appears to be safe and effective in many cases, depending on CMN size and location. Major wound-related complications and scar-related complications occurred more frequently with large/giant CMN, whereas anatomical deformities occurred with the majority of CMN with eyelid involvement.
KW - Anatomical deformities
KW - Congenital melanocytic naevi
KW - Core outcome set
KW - Excision
KW - Melanoma
KW - Satisfaction
KW - Scar-related complications
KW - Wound-related complications
UR - http://www.scopus.com/inward/record.url?scp=85146451622&partnerID=8YFLogxK
U2 - 10.1016/j.bjps.2022.10.048
DO - 10.1016/j.bjps.2022.10.048
M3 - Review article
C2 - 36652871
AN - SCOPUS:85146451622
SN - 1748-6815
VL - 77
SP - 430
EP - 455
JO - Journal of Plastic, Reconstructive and Aesthetic Surgery
JF - Journal of Plastic, Reconstructive and Aesthetic Surgery
ER -
