Removal of congenital nevi--cons.

Reviews of the literature support the view that melanomas arise in LCHN as well as other types of nevi and normal skin. The cases reported in the literature show a pediatric predominance. It is impossible to develop predictable figures by combining incidences of nevi with historical data from case reports. A long-term registry and follow-up are needed. In the meantime, each case should be treated individually, keeping in mind that especially in LCHN, it may be impossible to remove all melanocytes both in skin and in the CNS. Associated neuromelanosis may be present. Whether or not surgery is done, the patient must be carefully followed. Large nevi may be observed and changes that are noted should be biopsied early. Even with biopsy, the diagnosis may be unclear because some changes may be pseudomalignancies rather than true malignancies. Parents of infants should be informed of all possibilities and the complications of surgery adequately outlined. The adult with a LCHN should be informed that there is some risk. (It has been our experience that most adults prefer cosmetic revision of small areas and elect observation rather than excision.) As new techniques such as tissue expanders and more refined investigations to delineate extent of the nevus are found, it may be possible to adequately ablate more lesions in the future if a prospective study shows a convincing incidence of melanoma.