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Year : 2014  |  Volume : 15  |  Issue : 1  |  Page : 53-54

Giant congenital melanocytic nevus (bathing trunk nevus) in a neonate


Department of Dermatology, STD and Leprosy, Government Medical College and Associated SMHS Hospital, Srinagar, Jammu and Kashmir, India

Date of Web Publication2-May-2014

Correspondence Address:
Abid Abid Keen
Iqbal Abad, K.P Road, Anantnag - 192 101, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.131846

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How to cite this article:
Keen AA, Hassan I. Giant congenital melanocytic nevus (bathing trunk nevus) in a neonate. Indian J Paediatr Dermatol 2014;15:53-4

How to cite this URL:
Keen AA, Hassan I. Giant congenital melanocytic nevus (bathing trunk nevus) in a neonate. Indian J Paediatr Dermatol [serial online] 2014 [cited 2020 Nov 30];15:53-4. Available from: https://www.ijpd.in/text.asp?2014/15/1/53/131846

Sir,

Giant congenital melanocytic nevi (CMN) also known as "bathing trunk nevi" or "garment nevi" are large macular lesions with diameters over 20 cm that are present since birth and develop coarse terminal hair over a period of years. These giant pigmented nevi are a cause of great cosmetic concern and take a psychological toll on the patients and their family.

A 2-day-old neonate born of a non-consanguineous marriage by normal vaginal delivery to a primigravida with uneventful antenatal history presented with a pigmented patch involving the trunk and buttocks since birth. There was no history of any seizures or focal neurological deficit. There was no family history of similar disorder. General physical examination did not reveal any abnormality. Systemic examination was unremarkable. Ophthalmological examination was also normal. Cutaneous examination revealed an extensive brown-black patch covering the most part of trunk, buttocks and upper thighs extending up to the knee level, encircling the trunk circumferentially [Figure 1]. The surface was rugose, leathery, and with fine hairs. Multiple dark black satellite lesions of varying sizes were present all over the patch. There were multiple, smooth nodules, measuring 4-8 mm, soft, mobile, distributed unevenly over the underlying hyperpigmented patch [Figure 2]. Mucosae, hair, nail and palms and soles were normal. The parents did not approve of the skin biopsy. Hence, a clinical diagnosis of congenital giant melanocytic nevus (bathing trunk nevus) was made. Routine hematological and biochemical investigations were normal. Radiological investigations including X-ray chest, X-ray of vertebral spine as well as computed tomography head were normal.
Figure 1: An extensive brown-black patch covering the most part of the trunk, buttocks and upper thighs extending up to the knee level

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Figure 2: Multiple, smooth nodules, measuring 4-8 mm, soft, mobile, distributed unevenly over an underlying hyperpigmented patch

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CMN nevus is a benign neoplasm composed of nevomelanocytes, which occurs in about 1-2% of newborns. CMN nevi are classified as small (<1.5 cm in diameter), medium (1.5-19.9 cm in diameter), and large (20 cm in diameter or ≥5% of body surface area). Giant CMN nevus is a variant of CMN nevus, characterized by its extensive size and is defined as melanocytic nevus measuring more than 20 cm in its greatest dimension, occurring in approximately one in 2,00,000-5,00,000 births, with a female predominance. [1] The lesion is variously called bathing trunk, cape, vest, coat sleeve or stocking nevus depending on regional distribution. [2] The common site of giant congenital melanocytic nevus is lower back and thigh area. [3] The lesion involving the cervical area may be associated with leptomeningeal melanocytosis producing seizures, hydrocephalus and mental changes leading to death. Bathing trunk nevus besides causing social embarrassment may undergo malignant transformation in 13.7% of cases. [4] Characteristics such as multiple nevi (>50) or small satellite nevi around a larger central lesion are more concerning for development of melanoma. Patients with large or giant CMN also have a 10% incidence of neurocutaneous melanosis, a rare congenital syndrome that presents with multiple CMN nevi and melanocytic tumor cells in the central nervous system, specifically on the leptomeninges, arachnoid, and pia mater. [5]

Treatment options include staged excision with grafting, phenol chemical peels, dermabrasion, curettage, Q switch Ruby laser or just simple close observation. The use of cultured epithelial autografts have also been trialed in conjunction with Erbium-doped yttrium aluminium garnet laser ablation. [6]

 
  References Top

1.Cabrera H, Gómez ML, García S. Lipomatous melanocytic nevomatosis. J Eur Acad Dermatol Venereol 2002;16:377-9.  Back to cited text no. 1
    
2.Caro WA. Tumours skin. In: Moschello SL, Pillshury DM, Hurley HJ, editors. Dermatology. Philadelphia: WB Saunders Company; 1978. p. 1323-407.  Back to cited text no. 2
    
3.Mackie RM. Melanocytic naevi and malignant melanoma. In: Champion RH, Burton JL, Burns DA, Breathnach SM, editors. Textbook of Dermatology. 6 th ed. Oxford: Blackwell Scientific Publications; 1998. p. 1717-52.  Back to cited text no. 3
    
4.Russel JL, Reyes RG. Giant pigmented naevi. J Am Med Assoc 1959;1:2083-7.  Back to cited text no. 4
    
5.Chu WC, Lee V, Chan YL, Shing MM, Chik KW, Li CK, et al. Neurocutaneous melanomatosis with a rapidly deteriorating course. Am J Neuroradiol 2003;24:287-90.   Back to cited text no. 5
    
6.Whang KK, Kim MJ, Song WK, Cho S. Comparative treatment of giant congenital melanocytic nevi with curettage or Er:YAG laser ablation alone versus with cultured epithelial autografts. Dermatol Surg 2005;31:1660-7.  Back to cited text no. 6
    


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