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.