Treatment of large and giant nevi

Although the exact risk of malignant degeneration may never be determined, there is still evidence that large and giant nevi carry this potential. Excision and reconstruction are warranted, provided that they can be accomplished with an optimal aesthetic and functional outcome, but experience has demonstrated that some extensive lesions are best left to observation by the dermatologist (with selective surgery if atypical areas arise). NCM is a well-recognized disorder whose full implications have yet to be determined, but children with large and giant nevi, particularly in axial distribution, should be evaluated. The same goes for those with multiple satellite nevi. The presence of NCM is not at present a contra-indication to treating the cutaneous lesion. Experience with a large population of children with large and giant CMN has demonstrated that thoughtful application of the full spectrum of reconstructive options, heavily weighted toward the use of tissue expansion (as well as expanded pedicled and free flaps) can result in total or near-total excision of many of these extensive nevi with predictably good outcomes (Figs. 1-4).