Spontaneous Regression of Large Congenital Melanocytic Nevi,With a Halo Rim in 17 Children With Large Scalp and Trunk Nevi During 45 Years: A Review of the Literature

Background. Prior reports on large congenital melanocytic nevi (LCMN) do not provide a clear management approach to physicians to advise parents or patients. Whether the presence of a halo around the nevus can guide management has not been fully explored. Design. Children born with an LCMN were observed without active intervention. Objectives. (1) To guide physicians, health providers, and parents in the management of CMN. (2) To ascertain the value of the absence or presence of a halo component of the nevi. (3) To reaffirm the diagnostic value of dermoscopy for evaluation of CMN. Materials and Methods. This was a clinical study of 45 children referred to our pediatric dermatology clinics from 1971 to- 2018. Results and Outcome. Of 45 children, 9 were lost to follow-up and 36 were followed for 6 months to 47 years. In follow-up of 17 children with a scalp CMN, spontaneous regression occurred in 6 patients. In follow-up of 5 children with a trunk LCMN, spontaneous regression occurred in 1 patient and excisional surgery was done in 4 patients. Quality of life was excellent in 35 children, but poor in 1 patient during multiple injections and excisions. Conclusions. A conservative approach to management of children with CMN, large and small, is safe, cost-effective, and results in excellent quality of life and cosmetic outcomes. Dermoscopy, a simple in-office procedure, can reassure the examiner that the congenital nevus is benign. A halo rim was present in 12 (80%) of 15 scalp CMN. The presence of a halo rim appears predictive of future regression of a CMN in the scalp or trunk.