Congenital Nevi

The management of small congenital nevi—less than a few centimeters in diameter—is controversial. The vast majority will never become malignant, but some experts feel that the risk of melanoma in these lesions may be somewhat increased. Since 1% of whites are born with these lesions, management should be conservative and excision advised only for lesions in cosmetically nonsensitive areas where the patient cannot easily see the lesion and note any suspicious changes.

Excision should be considered for congenital nevi whose contour (bumpiness, nodularity) or color (different shades) makes it difficult for examiners to note early signs of malignant change. Giant congenital melanocytic nevi (> 5% BSA) are at greater risk for development of melanoma, and surgical removal in stages is often recommended.