Surgical treatment of pigmented melanocytic nevi depending upon their size and location.

Cutaneous melanocytic nevi may cause cosmetic defects and represent a risk of malignant transformation. Most problems are posed by nevi of the face or those covering large areas of the body, the so-called giant congenital nevus. From 1986 until 1995, 295 patients with pigmented nevi underwent surgical treatment. The method employed depended upon the size and location of the melanocytic nevus. Results were evaluated according to a three-stage scale with consideration of the cosmetic outcome and satisfaction of the patients. Good results were obtained in 280 patients, satisfactory ones in 11 patients, and unsatisfactory ones (requiring corrective treatment) in 4 patients. Small and medium size nevi (up to 5 cm in diameter) can be removed in a one-stage procedure with suturing of the wound, local plasty or free-tissue skin graft. Blepharal and central facial lesions are best reconstructed with full-tissue skin grafting. Large nevi (over 5 cm in diameter) mandate a staged excision or removal at one-stage with prior use of a tissue expander or presuturing. Giant nevi require staged treatment with the use of an intermediate thickness skin graft or removal of superficial layers of the nevus, always preceded however by a histopathological examination.