Extraordinary Large Giant Congenital Melanocytic Nevus Treated with Integra Dermal Regeneration Template

Kim A. Tønseth, MD, PhD,*†‡Charles Filip, MD, PhD,*†Robert Hermann, MD,*Harald Vindenes, MD,* and Hans Erik Høgevold, MD, PhD*†

CASE REPORT


The patient was born abroad after a normal pregnancy. Immediately after delivery, a very large voluminous GCMN of the back covering about 16% of the total body surface area and additional multiple smaller nevi on the body were demonstrated. The patient and his family immigrated to Norway, and he was referred to our hospital when he was 1.5 years old (Fig.1). His main complaints were severe itching and difficulty in normal everyday activities and sleeping due to the large tumor.

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Fig. 1.
Preoperative status of the extraordinary large GCMN on the back, covering 16% of the total body surface area.

Based on the patient’s complaints, we decided to perform a two-stage operation with (1) excision of the large tumor (Fig.2) and coverage with Integra (Fig.​3) and (2) 3 weeks later split-thickness skin transplantation of the 100% vascularized Integra. The split-thickness skin transplantation was harvested with 0.008-inch thickness, meshed 1:1.5, and fixed with vacuum-assisted closure technique at 80 mm Hg (Smith & Nephew, Hull, United Kingdom). Due to multiple smaller nevi on the rest of the body, the split-thickness skin transplant was harvested including these lesions. After additional 5 days, the bandage was removed and 90% of the split-thickness skin transplant had healed. A secondary split-thickness skin transplantation procedure was performed, and 2 months after the primary operation the defect was completely healed (Fig.4).

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Fig. 2.
Excision of the GCMN. Due to its large size, it was split in the midline.

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Fig. 3.
View after covering the skin defect with Integra dermal regeneration template.
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Fig. 4.
Two-month postoperative result.

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