Treatments of palpebral congenital melanocytic nevus: a systematic review

Camargo, Cristina Pires; Saliba, Marita; Saad, Elio Assaad; Milan, Milanie; Caldera, José Mauricio

doi:10.1590/acb384823

Acessibilidade / Reportar erro

Brasil

Acta Cirúrgica Brasileira

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Review Article • Acta Bras Cir 38 • 2023 • https://doi.org/10.1590/acb384823 copy

Treatments of palpebral congenital melanocytic nevus: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

Palpebral congenital melanocytic nevi (PCMN) is a rare congenital skin lesion affecting the eyelids that can lead to cosmetic and psychological concerns and potential health risks such as malignancy. Several authors have analyzed therapeutical strategies to treat PCMN. However, there was no consensus in the literature. This systematic review aimed to evaluate the effectiveness, safety, and success of treatments of PCMN.

Methods:

We conducted a systematic review following PRISMA guidelines from October 2022 to April 2023. We included all types of study designs that described or compared PCMN treatments and interventions, as well as histology, recurrence, adverse events, patient satisfaction, and malignant transformation. The search strategy was based on specific search words through the following databases: PubMed, Embase, Latin American and Caribbean Health Sciences Literature (Lilacs), Web of Science, and Scopus. Ongoing studies and gray literature studies were included.

Results:

We analyzed 25 case reports with 148 participants. The effectiveness, success, and satisfaction with various treatments for PCMN depend on the specific treatment method and the individual patient’s case.

Conclusions:

Most of the studies showed that surgical procedures (exeresis) are able to treat PCMN in the eyelid. The variability in outcomes emphasizes the importance of further research to better understand the most effective and safe approaches for treating congenital melanocytic nevi.

Key words
Nevus, Pigmented; Eyelid Neoplasms

Study_id	Study design	Population	Treatment	Endpoints	Results	Adverse events
Gu et al.⁷7 Gu Y, Chang S-J, Ma G, Wang Y, Zhu J, Chen H, Lin X. Treatment of Congenital Melanocytic Nevi in the Eyelid and Periorbital Region With Ablative Lasers. Ann Plast Surg. 2019;83(4S):S65–9. https://doi.org/10.1097/SAP.0000000000002094 https://doi.org/10.1097/SAP.000000000000...	Case series	20 participants (14 females, six males)	Carbon dioxide laser (n = 11); Erbium:yttrium aluminum garnet laser (n = 2); Association (n = 7); Two to 21 sessions	Six months after treatment by visual assessment and Lab* color space, measuring color value of the lesion and normal skin	25% poor; 20% fair; 25% good; 20% excellent; 10% clear	50% fair or poor outcome, requiring surgical excision
Zeng¹⁸18 Zeng Y. Divided nevus of the eyelid: successful treatment with CO 2 laser. J Dermatol Treat. 2014;25(4):358–9. https://doi.org/10.3109/09546634.2012.756970 https://doi.org/10.3109/09546634.2012.75...	Case report	25-year-old female, right eyelid with 1.2 × 1.5 cm in size in the lower eyelid and 0.8 × 1 cm in the upper eyelid	CO2 laser for 15 minutes foreach lid	Normal tissues became visible after ablation; Thermal damage of the lower dermis avoided	Patient satisfied	Edema, incrustation, and erythema; Minimal repigmentation of upper lid; Superficial scar of the lower lid; Hypopigmentation on both wounds at the five-month follow-up
Abrusci and Benzecry¹⁹19 Abrusci V, Benzecry V. Congenital melanocytic nevus on the lower eyelid treated with continuous wave and superpulsed CO 2 laser followed by erbium laser. J Cosmet Laser Ther. 2017;19(4):219–21. https://doi.org/10.1080/14764172.2017.1293826 https://doi.org/10.1080/14764172.2017.12...	Case report	16-year-old female patient with medium right lower eyelid congenital nevus	CO2 and Er:YAG laser simultaneously	Total reepithelialization within 10 days; No complications during two-year follow-up	Excellent and very satisfactory outcomes with absence of scarring	Satisfactory 3 × 7-mm post-inflammatory lightly hyperpigmented area, not corresponding to melanocytic nevus as per dermatoscopic assessment
Ponomarev et al.²²22 Ponomarev IV, Topchiy SB, Pushkareva AE, Klyuchareva SV, Andrusenko YN. Treatment of Congenital Melanocytic Nevi With a Dual-Wavelengths Copper Vapor Laser: A Case Series. J Lasers Med Sci. 2021;12:e5. https://doi.org/10.34172/jlms.2021.05 https://doi.org/10.34172/jlms.2021.05...	Case report	55-year-old male and 30-year-old female patients with congenital melanocytic nevi on the forehead and lower eyelid	511 and 578 nm dual wavelength copper vapor laser radiations; 55-year-old patient: two sessions one month apart 30-year-old patient: three sessions of one-month interval	Immediate grayish appearance, narrow dark brown covering scab two or three days post-treatment, pink color after seven to 10 days when scab fell off	Three weeks healing time and no recurrences during 24-month follow-up	Slight erythema that resolved
Cho et al.²⁸28 Cho HJ, Lee W, Jeon MK, Park JO, Yang EJ. Staged Mosaic Punching Excision of a Kissing Nevus on the Eyelid. Aesthetic Plast Surg. 2019;43(3):652–7. https://doi.org/10.1007/s00266-019-01362-0 https://doi.org/10.1007/s00266-019-01362...	Case report	15 patients (10 women, five men, 13–73 years old) with congenital divided nevi (small, medium sized) involving eyelash-bearing area	Seven patients: laser therapy; Eight patients: concomitant excision or history of previous excision; One patient: skin graft; Three to six sessions to complete the procedure, and the entire procedure performed every four to six weeks	Assessment by checking postoperative lid margin irregularities, lid notching, delayed wound healing and closure, infections, partial/total decrease in hair along margin and recurrence	Patients’ satisfaction assessment through questionnaire; All patients satisfied	Partial loss of cilia in all patients
McDonnel and Mayou³²32 McDonnell PJ, Mayou BJ. Congenital divided naevus of the eyelids. Br J Ophthalmol. 1988;72(3):198–201. https://doi.org/10.1136/bjo.72.3.198 https://doi.org/10.1136/bjo.72.3.198...	Case report	Newborn female infant with left 2 × 2.5-cm pigmented divided nevus associated with thickening of the upper and lower eyelids and mild left eye ptosis	Dermabrasion	Decreased nevus size and pigmentation; Size and color reverted to initial presentation after four weeks	Two months postoperative assessment satisfactory with no pigmentation recurrence	None mentioned
Yap and Earley³³33 Yap LH, Earley MJ. The panda naevus: management of synchronous upper- and lower-eyelid pigmented naevi. Br J Plast Surg. 2001;54(2):102–5. https://doi.org/10.1054/bjps.2000.3514 https://doi.org/10.1054/bjps.2000.3514...	Case report	4-year-old boy with left congenital periorbital pigmented nevus; 25-year-old woman with congenital pigmented periorbital naevus associated with bleeding after minor trauma; 4-year-old girl with right congenital periorbital pigmented nevus; 23-year-old woman with congenital pigmented periorbital naevus affecting both right eyelids and right infraorbital region	4-year-old boy: nevus excision then reconstruction using full-thickness post-auricular skin graft; 25-year-old woman: lower-lid excision, including eyelashes, and reconstruction using full-thickness post-auricular skin grafts; 4-year-old girl: two-stage excision, reconstruction using full-thickness post-auricular skin graft, wedge excision required two years later; 23-year-old woman: numerous excisions and reconstruction using full-thickness post-auricular skin grafts	4-year-old boy, 25-year-old and 23-year-old women histology: benign compound nevus; 23-year-old woman: further wedge excision necessary two years after original excision; 4-year-old girl histology: intradermal pigmented nevus with extension to conjunctiva	Good or excellent result as judged by patient and/or parents	4-year-old girl: ophthalmologic opinion on scleral and conjunctival melanosis, but grafting not considered; 25-year-old woman: post-operative ectropion, corrected using lateral wedge excision; 23-year-old woman: epiphora due to close excision in lacrimal apparatus region
Papadopoulos et al.³⁵35 Papadopoulos O, Chrisostomidis C, Konofaos P, Georgiou P, Frangoulis M, Betsi E, Champsas G. Divided naevus of the eyelid, seven cases. J Plast Reconstr Aesthet Surg. 2007;60(3):260–5. https://doi.org/10.1016/j.bjps.2005.12.032 https://doi.org/10.1016/j.bjps.2005.12.0...	Case report	Four patients (three females, one male, aged from 17 to 54 years old)	Full-thickness excision of one-quarter of the lid and full-thickness skin grafts tocover defects	Full-thickness pentagon excision useful in debulking of nevi extending in posterior lamella of eyelids, maintaining good lobe apposition, and preserving eyelashes line	Successful	None mentioned
Yildirim et al.³⁴34 Yildirim N, Sahin A, Erol N. The surgical treatment of congenital divided nevus of the eyelid: a case report and review of the literature. Int Ophthalmol. 2009;29(1):45–7. https://doi.org/10.1007/s10792-007-9163-5 https://doi.org/10.1007/s10792-007-9163-...	Case report	16-year-old boy with continuous pigment lesion affecting upper and lower left eyelid, extending vertically to tarsal conjunctiva of both eyelids	3-4 mm of normal skin surrounding nevus and 1-2 mm from tarsoconjunctival area removed; Newly formed eyelid margin covered by musculocutaneous flap; Minimal lateral tarsorrhaphy to reduce interpalpebral width	Follow-up at six months; Use of lateral musculocutaneous flap for successful results; Patient’s age, gender, diameter of lesion and degree of involvement of tarsus to be kept in mind before surgery	Satisfactory six months post-surgery	None mentioned
Ghosh et al.³⁶36 Ghosh YK, Abu-Ain M, Ahluwalia HS. One Stage Management of a Giant Kissing Naevus. Orbit. 2010;29(3):175–6. https://doi.org/10.3109/01676830903488811 https://doi.org/10.3109/0167683090348881...	Case report	39-year-old female with large kissing nevus spanning central two third of lower and upper left eyelids	Surgical reconstruction in one-stage fashion, by splitting posterior and anterior lamellae and debulking upper/lower lid lesions	Follow-up atone week; Healing of upper lid defect at follow-up, lower lid graft taken nicely with good lid position and no exposure	Great aesthetic and functional results	None mentioned
Rajput et al.⁹9 Rajput GC, Mahajan D, Chaudhary KP, Deewana V. Kissing naevus arising from neural crest cells presenting as upper and the lower lid mass. J Neurosci Rural Pract. 2015;6(3):417–9. https://doi.org/10.4103/0976-3147.158796 https://doi.org/10.4103/0976-3147.158796...	Case report	40-year-old female with melanocytic nevi involving both eyelids	Surgery with canthotomy and cantholysis; Lid repair in both lids by direct suturing method	Histology: stratified squamous epithelium with nests of nevus cells at dermal-epidermal interface	Healed lid skin and improved visual acuity on follow-up	Healing of lid skin; Improvement of visual acuity to 6/36 in left eye
Bayramiçli et al.³⁷37 Bayramiçli M, Ersoy B, Şirinoğlu H. Surgical Management of a Congenital Panda Nevus With Preexpanded Triple Forehead Flaps and Temporal Island Flap: J Craniofac Surg. 2012;23(5):1396–8. https://doi.org/10.1097/SCS.0b013e3182587a04 https://doi.org/10.1097/SCS.0b013e318258...	Case report	14-year-old boy with congenital panda nevus involving upper and lower eyelids, eyebrow, part of the malar eminence and nasal dorsum	Staged excision of the lesion and defect; Reconstruction with expanded forehead flaps and temporal island flap with hair-bearing skin	After three months: surgery for minor revisions; After 14 months: final stage of surgical treatment	Satisfactory functional and aesthetic results	None mentioned
Desai et al.³⁸38 Desai SC, Walen S, Holds JB, Branham G. Divided nevus of the eyelid: Review of embryology, pathology and treatment. Am J Otolaryngol. 2013;34(3):223–9. https://doi.org/10.1016/j.amjoto.2013.01.004 https://doi.org/10.1016/j.amjoto.2013.01...	Case report	8-year-old male patient with congenital nevocellular nevus	Excision and local advancement flap with V to Y closure of defect lateral to lateral canthus and full-thickness skin graft for eyelid reconstruction	Final pathology: congenital nevocellular nevus	Satisfactory	No complications
Kasai and Ogawa³⁹39 Kasai K, Ogawa Y. The successful treatment of a divided nevus on a young patient using a modified Kunhnt-Szymanowski procedure. Ophthal Plast Reconstr Surg. 1990;6(3):181–4. https://doi.org/10.1097/00002341-199009000-00005 https://doi.org/10.1097/00002341-1990090...	Case report	16-year-old boy with nevus involving lower and upper eyelids (8 mm inferior and 5 mm superior to eyelashes, respectively)	Surgical excision using the Kuhnt-Szymanowski procedure, and simple excision on the upper eyelid	No ectropion within 11 months follow-up, and nearlyinvisible scar	Complete removal of the lower ciliary border nevus	None mentioned

Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia https://actacirbras.com.br/ - São Paulo - SP - Brazil
E-mail: actacirbras@gmail.com

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Corresponding author: cristinacamargo@usp.br