| BackgroundCongenital pigmented nevus also known as congenital melanotic nevus, originated in the neural crest[1].The pigmented nevus occurred within 6 months after birth was called congenital pigmented nevus,6 months later was called acquired pigmented nevus[2].From the pathological, Ackerman proposed three clues to the pathological diagnosis of congenital pigmented nevus[3]. Because of the possibility to become the malignant melanoma and some foreign researchers believe that the Congenital pigmented nevus is likely to deteriorate[5][6],so many patients ask for treatment[7]. The current treatments are surgery, liquid nitrogen freezing, and laser treatment and so on. However, in practice, liquid nitrogen, laser treatment for nevus has limitations, and there is less recurrence and fewer adverse reactions after surgery [8].We collected 76 cases of hospitalized patients with congenital pigmented nevus from 2005 to 2010 in the affiliated hospital of medical university in the middle of china. We analyzed the clinical manifestation, pathology depth, and inpatient surgery to provide some clues for understanding the clinical features of congenital pigmented nevus, pathology depth and surgical treatment. Materials and methods1. Cases collection.We collected 107 hospital record of plastic surgery department, which were diagnosed as pigmented nevus, in the First Affiliated Hospital of Zhengzhou University from January 2005 to September 2010 and collect all the 105 pathological examination of skin damage biopsy. Excluding the medical records of 22 acquired pigmented nevi,5 medical records were not operated on,2 medical records without pathological section and 2 medical records were diagnosed as sebaceous nevus,76 copies of congenital pigmented nevus and 78 skin lesions were selected for research from 107 medical records.2. Pathology Group and Pathology Depth measurementAccording to pathological characteristics, the selected congenital pigmented nevi are classified into three groups:intradermal nevus, dermoepidermal nevus and compound nevus. Through microscope (OLYMPUS CH20, Olympus (China) Co., Ltd.), using 10 times magnification eyepiece (Meckler WF10×, Meckler microscope companies) and 10 times magnification objective to measure the depth measurement of pigmented nevi. Pathology Depth is defined as the maximum depth of pathological sections of nevi from granular layer of epidermis to the deepest lesions in the vertical distance.Performance and satisfaction after surgery:the researcher find patient's the telephone number from the every selected medical record to pay a return visit for the performance and satisfaction. We define satisfaction as mild scars or minor pigmentation after surgery, which the patient does not think will affect beauty. The general is defined as obvious scars or obvious pigmentation after surgery, which the patient thinks will affect beauty slightly and the dissatisfaction is defined as large scar or severe pigmentation, which obviously affect the patient's beauty. Meanwhile the question, whether the pigmented nevus is recrudesced, is designed during the return visit 3. Main statistic:The relationship between pathology depth of skin lesions of congenital pigmented nevus and diameter of lesions, location, course, pathologic classification.4. Statistical analysisAll data were processed by software SPSS17.0, using analysis of variance, and linear regression statistics. F test and T test are used in data measurement, P<0.05 was considered statistical.Results1. Clinical manifestations:In the 76 cases of patients with congenital pigmented nevus, the number of male patient's case is 43 (56.58%) and the female is 33 (43.42%), sex ratio is 1:0.77.74 patients removed one nevus and 2 cases removed two nevus. The patient's age is between 13 days and 58 years, the average age is 9.51 years±11.06 years. The course is between 13 days and 58 years and the average time is 9.50 years±11.06 years.1 case was diagnosed as congenital giant nevus,65 cases were diagnosed as congenital medium-sized nevus (85.53%),10 cases were diagnosed as congenital lentigo (13.16%). The diameter of skin lesions of 10 cases is less than 10mm (12.82%). The diameter of skin lesions of 34 cases is between 11mm to 20mm (43.59%). The diameter of skin lesions of 34 cases is bigger than 20mm (43.59%). There are 46 cases (58.97%) with the surface of hair and 32 cases without hair (41.03%). There are 64 cases with black nevus (82.05%),11 cases with dark brown (14.10%),3 cases with light brown. Parts of the distribution:54 cases of head and face (69.23%),9 cases of torso (11.54%),15 cases of limbs (19.23%).2. Pathology DepthIn the 78 nevus, there are 42 intradermal nevi (53.85%), the pathological depth range 3.42mm-11.64mm, the average depth of pathology 4.30mm±1.32mm. There are 26 compound nevi (33.33%), the pathological depth range 3.02mm-3.96mm, the average depth of pathology 3.32mm±0.23mm. And there are 10 dermoepidermal nevi (12.82%), the pathological depth range 0.14mm-0.36mm, the average depth is 0.29mm±0.07mm. In histopathological observation,10 patients with nevus cells deep at the bottom of the epidermis (12.82%),34 cases of nevus cells deep dermis (43.59%),33 patients with the nevus cells deep in fat (42.31%), and 1 case with nevus cells deep in the muscle tissue (1.28%).3. Statistics of anesthesia and surgical methods.The 21 cases were used local infiltration anesthesia (36.73%).55 cases (63.26%), children who can not be cooperated and patients with large lesions were used general anesthesia method.Skin lesions of fusiform excision were removed in the direction of dermatoglyph outside the edges 2mm-3mm.10 cases (12.82%), the diameter of skin lesions is less than 10mm, were sutured directly.34 cases (43.59%), the diameter of skin lesions is between 11mm and 20mm, were used random skin flap.34 cases (43.59%), the diameter of skin lesions is larger than 20mm-wide, were used thick skin which were sutured directly.1 case with particularly large skin lesions were used fractional resection,6 months later the scar become soften and were cut for second time when the skin become flab. Full-thickness skins were taken from the abdomen in 24 cases, 9 cases from the medial upper arm, and 1 case from the inner thigh.4. In hospital:in all the 76 cases, nevi were cut out completely in one operation in 74 cases (97.37%),2 cases required reoperation (2.63%). Hospitalization time is range from 10-18 days, with the average time is 13.09 days±1.64 days; hospitalization cost is range 1734.69 to 14,754.06 RMB, the average cost is 5069.58±2392.82 RMB.Conclusions1. The small and medium-sized congenital pigmented nevus is more common than giant-sized congenital pigmented nevus 2. Against malignant transformation and the beauty factor is an important reason for patients.3. The pathological depth of congenital pigmented nevus has relationship with its type. The intradermal nevus has most pathological depth, and the compound nevus followed, and the least one is dermoepidermal nevus4. The pathological depth of congenital pigmented nevus has relationship with its size. The pathological depth is in direct proportion to the size.5. The pathological depth of congenital pigmented nevus has relationship with its location, the deepest part is in the torso, and the limbs followed, the least one is in the head and face.6. The pathological depth of congenital pigmented nevus has relationship with the course of disease. The pathological depth is in direct proportion to the course of disease.7. Congenital pigmented nevi should be treated early, it is recommended to have an operation in 8 to 10 years old.8. It is better to have an operation for congenital pigmented nevus. It is recommended to send routine pathological examination. |
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