IDEAS AND INNOVATIONS
Hydrosurgery as a new non-excisional treatment method
for giant congenital melanocytic nevi
Anne-Marie C. C. Stoel
Jan Jeroen Vranckx
Received: 30 April 2013 / Accepted: 30 June 2013 /Published online: 13 August 2013
Springer-Verlag Berlin Heidelberg 2013
Abstract Giant congenital melanocytic nevi (GCMN)
distress but may also be complicated by involvement of
the central nervous system and malignant deformation.
GCMN treatment remains a point of discussion. We sug-
gest hydrosurgery as a new non-excisional treatment meth-
od for GCMN. Hydrosurgery has a lot of advantages in
comparison to other non-excisional techniques. We were
able to remove the epidermis and upper layer of the dermis
of these GCMN in a more precise and controlled manner.
The operation time was shorter, there was less blood loss,
and shorter anesthesia times. Hydrosurgery is an easier and
more controllable alternative to dermabrasion and curettage
in the treatment of GCMN.
Level of Evidence: Level V, therapeutic study.
Keywords Giant congenital melanocytic nevi
Giant congenital melanocytic nevi (GCMN) are currently
defined as brown or black moles that are present at birth,
with a projected adult size (PAS; defined as the largest
diameter) of >20 cm .
The incidence of giant congenital melanocytic nevi is 1 in
every 20,000 new births . Their appearance can cause
psychological distress to both patients and their parents,
and children with GCMN are at increased risk for developing
social and emotional problems [2, 3].
Histologically, GCMN contain nevus cells within the
lower two thirds of the dermis and within subcutaneous
tissue. The nevus cells can also extend into fascia or muscle.
Nevus cells can be observed around sebaceous glands,
eccrine and apocrine sweat glands, hair follicles, blood ves-
sel walls, and nerves [2, 3]. Extra-cutaneous deposits of
melanocytes may be associated and have been described
in the mucosa and in retroperitoneal and leptomeningeal
Complications of giant congenital melanocytic nevi in-
clude local symptoms , psychosocial dysfunction, surgi-
cal complications , neurological complications , malig-
nant melanoma [2, 4], and possibly other tumors of the
central nervous system (CNS) .
The risk of melanoma has long been overestimated and
seems to be low for small congenital melanocytic nevi
(CMN). This complication has only been observed in
GCMN with a PAS >40 cm, with an incidence of 4 % [1, 4].
In contrast, neurological complications seem to be
with a PAS >40 % [1, 4]. The most frequent complica-
tion is neuromelanosis (NM), which is characterized by
melanocytic proliferation in the CNS. Risk factors for NM
Presented at the Autumn Meeting of the Royal Belgian Society for
Plastic Surgery in Brussels, Belgium on 10 November 2012
Electronic supplementary material The online version of this article
(doi:10.1007/s00238-013-0873-9) contains supplementary material,
which is available to authorized users.
A.<M. C. C. Stoel (*)
J. J. Vranckx
Department of Plastic, Reconstructive and Aesthetic Surgery,
University Hospitals Leuven, Herestraat 49, 3000 Leuven,
Department of Dermatology, University Hospitals Leuven,
Herestraat 49, 3000 Leuven, Belgium
Eur J Plast Surg (2014) 37:233–240