Clinical analysis of serial (staged) excision for congenital melanocytic nevi: A single-center experience

Background: Serial (staged) excision of congenital melanocytic nevi (CMN) is an important treatment option for medium-sized CMN. However, few studies have investigated the outcomes of serial excision in detail. Objective: We report our experience regarding serial excision of CMN, including methods to effectively reduce the procedural stages and scar length. Methods: We retrospectively reviewed medical records of patients with CMN treated between 2008 and 2015; 33 patients (7 men and 26 women) underwent serial excision. Results: The CMN were located on the face (n-11), arms (n=6), legs (n=ll), and other areas of the body (n=ll), including the back (n=2), chest (n=l), deltoid region (n=l), and buttocks (n=l). The mean CMN area was 19.7 cm2. The mean number of surgical stages was 2.2. The mean interval between surgeries was 10.6 months. A marginal S-shaped incision along both edges of the nevus was preferred over elliptical excision, to reduce scarring. Pulsed dye, erbium:yttrium-aluminum-garnet (YAG), neody mium-dopcd: YAG, and carbon dioxide fractional lasers were used to improve the final outcomes and minimize scarring. Conclusion: Serial excision is an effective treatment option associated with greater patient satisfaction, particularly for medium-sized and hairy CMN. Conventional elliptical serial excision is associated with the formation of elongated scars and sacrifices normal skin adjacent to the lesion. The marginal S-shaped incision reduces scarring by dispersing mechanical tension on the scar without skin wastage. Compared with the elliptical excision method, the marginal S-shaped incision reduces the number of surgical stages and results in a cosmetically superior scar. Performing a marginal S-shaped incision is technically challenging in certain anatomical locations, such as the eyes, nose, and mouth. Therefore, it is necessary to combine this procedure with erbium:YAG and neodymium-doped:YAG ablation. (Korean J Dermatol 2019;57(9):527~531).