What are my options?
There are several reasons that patients sometimes decide to undergo removal of a large nevus. Most of the time, the overriding reasons to remove a congenital pigmented nevus are first to reduce melanoma risk and second to improve appearance which can be fundamental to improving a patient’s overall psychosocial state. Other reasons to remove a nevus may be to improve the strength, texture, sensation, and sweat gland activity of the affected area.
Is Removal Possible?
Small nevi can be removed by simple surgical excision. The nevus is cut out, and the adjacent skin stitched together leaving a small scar. Removal of a large congenital nevus, however, requires replacement of the affected skin. While it is almost impossible to remove every cell of a large nevus, the goal is to remove as many cells as possible while at the same time preserving function and minimizing scarring.
"Success" is in the eye of the beholder
What is successful to one person may not be successful to another person. Reducing or removing cancer risk might be considered so important, that one might actually call a procedure that results in unsightly scars a success. To another person, any scarring at all may be considered a failure.
There is such a thing as a nevus that is too large to remove.
Is Removal the Best Option?
Although information about congenital pigmented nevus removal is often the first thing a new nevus parent wishes to learn about, removal is certainly not always the best option. Every case is different and removal is a personal decision that must be made with the help of an experienced doctor.
Cancer Risk – Does Removal Help?
Nobody knows absolutely for sure if removing a nevus reduces or removes the risk of skin cancer. Since skin cancer is so common, there is no way of knowing if a person with a large pigmented nevus actually got it because they have a large nevus, or if it would have occurred even if they had been born without a nevus. Common sense dictates that it’s likely that having a large congenital melanocytic nevus increases the chances of skin cancer, but "how much?" remains to be better understood. Common sense also dictates that removing some melanocytes from the skin should reduce the risk of skin cancer, but again, more information is needed to determine the actual benefits.
Nevus Outreach collects more data on large nevi than anyone, and is using that data to find the answers you seek.
What are the Negative Effects of Nevus Removal?
Removal procedures are major surgeries, and require use of general anesthesia. Removal of very large nevi is typically accomplished by performing multiple surgical excisions over time.
Any major surgery carries risk and the possibility of a painful recovery. Only you and your doctor can decide if nevus removal is the right course of action for you.
It is important to remember that a nevus cannot be removed without leaving a scar. Scarring may be minimized at the hands of a highly skilled, experienced surgeon, though, so it is recommended you seek out a surgeon you can trust.
How is Nevus Removal Performed?
When small nevi are removed, the surrounding skin is simply pulled together and stitched up. Removal of a large nevus involves the replacement of the affected skin. Skin can be transferred from another area of the body (grafting), or adjacent skin can be stretched, then used to cover the area where the nevus was removed (tissue expansion). There are many details about the surgery you should consider and it is best to consult a surgeon experienced in the treatment of giant nevi.
There are limits to the skin grafting and tissue expansion procedures. You can only harvest so much additional skin from one person. Can another person donate skin? Not as easily as you might think. This is not commonly done and presents many risks and challenges. Can’t they just grow some artificial skin like I saw on TV? No, sorry. That skin does not have all the other tissue underneath it that the patient needs like muscle, fat and blood vessels. Artificial skin can keep a burn victim alive, but it is usually not a viable option for nevus removal.
More on Tissue Expansion
As of 2013 the most practical solution used by the greatest number of patients with large nevi to the greatest degree of success is called “tissue expansion”. This involves implanting a temporary expander under the patient’s skin, expanding it over time by filling it with salt water, then taking it out and harvesting the newly expanded skin. This can be done on many parts of the body, and can be adjacent or not adjacent to the nevus being removed.
There is a limit to how much skin can be expanded. It depends on where it is, and the individual patient. Babies are generally considered easier to expand than older people, but many surgeons are reluctant to use expanders on babies. However, the most experienced surgeons are generally interested in getting to work on it sooner than later for many good reasons.
Surgical removal of part of your skin will leave a scar. How much of a scar depends on all these same factors again. Different patients are more prone or less prone to significant scarring. If there is a lot of skin tension where the surgery took place, this can cause more scarring. If a large area was removed, this will result in more scarring than if a small area was removed. If the surgeon is not skilled, the scarring could be worse than if the surgeon is more skilled.
Think of it this way: If you’re going to have a nevus removed, you will be trading it in for a scar. How bad a scar depends on all the above considerations, some of which are almost completely unknown until after you’ve gone through with it.