The risk of melanoma
In the past, the perceived risk of melanoma associated with CMN was estimated as high as 50% in the thought framework of the Changing Nevus. The advice given for CMNs of all sizes was generally to consider prophylactic removal “if possible” due to the potential elevated risk of developing melanoma.
However, more recent and reliable studies provide a much lower estimate of the melanoma risk: the risk appears to be not elevated in smaller CMNs (<20cm PAS) compared to the general population and also seems to be lower in giant CMNs (>40cm PAS) than previously thought. Additionally, approximately half of these melanomas occur in the central nervous system, making them non-preventable through cutaneous surgery. Furthermore, removing the entire CMN in these larger cases is practically very challenging to impossible. It is also uncertain where a potential melanoma may arise within the nevus.
Many medical experts advise against prophylactic excision for all sizes of CMNs. However, partial removal may be considered in the following cases:
- Suspicious areas
- Discomfort or difficulty in monitoring (e.g., hard-to-reach areas)
- Cosmetic preference
In practice, the indication for treatment to reduce the risk of malignancy will still exist, but this is not a primary reason to recommend prophylactic removal for all CMNs.
There are several treatment options to remove a naevus.
Excision or laser treatment depends on the size and location of the congenital nevus. Treating the congenital nevus does not reduce the risk of developing melanoma.
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