Abstract
BACKGROUND: Congenital giant melanocytic nevus (GCMN) is a rare congenital lesion associated with potential risks of malignant transformation and neurocutaneous melanosis, which severely impacts patients' appearance and psychological health. Early intervention is crucial, and skin tissue expansion has been recognized as a primary surgical approach. This study aims to explore the feasibility and clinical efficacy of early treatment of GCMN using skin tissue expansion. METHODS: A retrospective study was conducted on 68 patients with GCMN who underwent skin tissue expansion treatment in the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, from October 2013 to December 2022. A total of 214 kidney-shaped expanders were implanted, and the surgical approaches included single-stage expansion and repeated expansion. Complication rates were calculated on both a per-patient and per-expander basis, with comparative analyses performed across different age groups and between internal and external expander ports. Long-term outcomes, including growth and development, symmetry, and functional status, were evaluated using objective criteria. RESULTS: Among the 68 patients, 32 (47.06%) had nevi located on the head and face, 24 (35.29%) on the trunk, 7 (10.29%) on the upper limbs, and 5 (7.35%) on the lower limbs, with all patients presenting multiple satellite lesions. A total of 214 expanders were implanted, with 22 patients receiving 1 expander, 16 receiving 2, 11 receiving 3, 4 receiving 4, 6 receiving 5, and 9 receiving more than 5. Of these expanders, 42 were internally placed and 172 were externally placed. All patients had postoperative drainage tubes. The average hospital stay was 15.13 days (range: 5-107 days), and the average expander removal time was 83.58 days (range: 13-218 days). The follow-up period ranged from 5 to 112 months (mean: 43.53 months). The per-patient complication rate was 69.12% (47/68), and the per-expander complication rate was 43.93% (94/214). No significant differences in complication rates were observed among different age groups (P > 0.05) or between internal and external ports (P > 0.05). Long-term follow-up revealed no growth retardation, trunk asymmetry, scoliosis, or limb developmental disorders; all patients maintained normal limb function and were satisfied with the cosmetic outcomes of the second-stage flap transfer. CONCLUSION: Skin tissue expansion is a safe and ideal surgical method for the early treatment of congenital giant melanocytic nevus, as it effectively improves patients' appearance, ensures satisfactory long-term functional and cosmetic outcomes, and does not increase the risk of complications or adversely affect growth and development.