Recent Data on the Risk of Malignancy in Congenital Melanocytic Nevi: The Continuing Debate on Treatment

Hernández, A.; Torrelo, A.

doi:10.1016/S1578-2190(08)70230-0

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Abstract

Congenital melanocytic nevi (CMN) have traditionally been considered a risk factor for the appearance of melanoma, but the true incidence of malignancy is unknown. Although various studies have attempted to quantify it, the results are highly variable and it is difficult to decide on the best therapeutic approach to take. Consequently, for some time the management of CMN has depended more on personal experience than on clear scientific evidence. The most recent studies performed in large patient series indicate that the risk of malignancy in CMN is much lower than expected and mainly affects large lesions involving the axial midline. In addition, it appears that a number of melanomas develop on the site of partially or completely excised lesions, or even away from the CMN itself, making the appropriateness of prophylactic surgery increasingly doubtful.

Key words:

congenital melanocytic nevus

melanoma

risk

Resumen

Los nevus melanocíticos congénitos (NMC) se han considerado tradicionalmente un factor de riesgo para la aparición de melanoma, pero se desconoce la verdadera incidencia de la malignización. Aunque numerosos trabajos han tratado de cuantificarla, los resultados son muy dispares y resulta difícil decidir qué actitud terapéutica es la más adecuada. Por este motivo, durante mucho tiempo el manejo de los NMC ha dependido más de la experiencia personal que de una auténtica evidencia científica. Los últimos estudios realizados en series amplias de pacientes reflejan que el riesgo de malignización de los NMC es mucho más bajo de lo que se creía, y afecta principalmente a lesiones de gran tamaño localizadas sobre el axis. Además, parece que un considerable número de melanomas se desarrolla sobre lesiones parcial o totalmente extirpadas, e incluso fuera del propio NMC, por lo que la necesidad de la cirugía profiláctica es cada vez más controvertida.

Palabras clave:

nevus melanocítico congénito

melanoma

riesgo

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