Congenital nevocellular nevus: a review of the treatment controversy and a report of 46 cases.

Because congenital nevocellular nevi can be distinguished clinically and histologically from acquired nevi, and because of their apparent increased potential for malignant degeneration, we favor complete one-stage excision of these nevi, regardless of the size of the lesion or the age of the patient, at the earliest opportunity, whenever such surgery is feasible and practical. If there is a question about the clinical diagnosis, a cutaneous punch biopsy can help determine the true nature of the lesion. Significantly, Walton et al. and Rhodes and coworkers found discrepancies in the literature concerning the level of nevus cells in neonates. They concluded that until these differences are reconciled, nevus cells in the deep reticular dermal collagen may be a sufficient, but not a necessary criterion for the diagnosis of congenital melanocytic nevus. We currently favor complete one-stage excision of congenital nevocellular nevi and feel that treatment by tangential excision or dermabrasion require further study. Finally, we present this paper as "advice" not only to the three authors who, in a recent issue of the British Journal of Plastic Surgery, requested it, but also to all clinicians. Hopefully, with time and further study, better criteria will be determined and a more definitive approach to this problem will be established.