According to Plastic Surgery experts at Bach Mai Hospital, the incidence of congenital melanocytic nevus CMN in newborns ranges from 0.2% to 1%. Most small and medium lesions do not have a major impact, but large (>20cm) and giant (>40cm or occupying ≥2% of the child's body surface) nevus are a danger that requires special attention because they can transform into malignant melanoma - the most malignant form of skin cancer.
Ideal intervention time for children with congenital melanocytic nevus
A 5-year-old girl has a giant pigmented nodule that covers her entire right arm and elbow, measuring up to 26cm. The nodule is dark black, thick-skinned, hairy, and has dozens of satellite nodules on her lower limbs.
Using the skin expansion technique, one of the important “weapons” of plastic surgery, doctors had to perform surgery up to 3 times for the child patient. Step by step, they placed the skin expansion bag on the back side, creating a skin flap to cover the injury, helping to maintain the function and shape of the child’s arm, minimizing bad scars, ensuring aesthetics.
A 7-year-old girl with a giant cyst on her back measuring 36x45cm, extending from the right anterior abdomen to the left lumbar region. The patient was treated with 7 partial surgical excisions (about 7 months/time). The elasticity of the child's skin was used to close the defect without skin grafting. When the patient was 11 years old, the entire cyst was completely removed, without complications.
Associate Professor, Dr. Pham Thi Viet Dung, Head of the Department of Plastic Surgery, Bach Mai Hospital, said that congenital melanoma is formed from mutations in the NRAS or BRAF genes during the embryonic period, leading to abnormal proliferation of pigment cells (melanocytes) under the skin.
Lesions can be flat or raised, light brown, dark brown or black, hairy, widespread. They can appear anywhere, from the face, trunk, arms and legs, even covering an entire area of the body.
"Unlike normal birthmarks, these microscopic nodules develop as the child grows, can cause inflammation, ulcers, secondary infections, affect movement or deform functional areas (face, neck, limbs), severely impacting the child's psychology and self-confidence," said Dr. Dung.
The ideal time for intervention is before the child is 3-6 years old, helping the child to go to school with a healthy appearance, avoiding inferiority complex. Especially with large cysts that require multiple surgeries, early treatment initiation is extremely important.
However, this expert said, safe anesthesia for young children also needs to be carefully considered. Normally, doctors rarely intervene before 18 months unless there are risk factors that require early intervention.
Multiple surgeries give children a new look
Associate Professor, Dr. Pham Thi Viet Dung said that each congenital melanoma requires different strategies and techniques.
Therefore, during consultation, doctors must discuss the contents of performing surgery once or many times; prioritizing the direction of the scar; choosing skin expansion, skin flaps or skin grafts to ensure aesthetic harmony and preserve the function of the surgical area.
"The result of surgery is not just a scar but also a child's appearance, confidence, and future. Therefore, we have to consider the surgical plan very carefully," said Dr. Dung.
With the strong development of skin expansion techniques, combined with flap creation, histology and experience from leading medical units such as Bach Mai Hospital, congenital melanocytic nodule surgery is increasingly achieving a high success rate, good aesthetics, few complications, and minimizing the impact on the physical development of children.
This expert emphasized that early diagnosis, thorough consultation for families and choosing a reputable center for treatment are the keys to helping children escape the burden of mental illness and enter life with complete confidence.
Source: https://nhandan.vn/benh-tiem-an-tu-dom-sam-mau-tren-da-post889351.html
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