Management of Intradermal Nevi with Congenital Features

Introduction to Intradermal Nevi

The American Academy of Pediatrics notes that congenital melanocytic nevi (CMN) are present in approximately 1-3.6% of newborns and carry a lifetime melanoma risk of 0.7-1.7% 1
Intradermal nevi have melanocytes confined to the dermis, which gives them their characteristic appearance and texture 2
When an intradermal nevus has "congenital features," it means the histopathology shows characteristics typical of nevi present at birth, such as deeper extension of nevus cells and involvement of adnexal structures 3

The risk of malignant transformation is higher in larger lesions (>40 cm in diameter) 3
The risk of malignant transformation is higher in lesions located on the trunk 3
The risk of malignant transformation is higher in multiple congenital nevi 3
The risk of malignant transformation is higher in nevi with atypical features or changes 1

Regular clinical and dermoscopic evaluation is essential for all congenital nevi, including intradermal types 1
Concerning changes that warrant immediate evaluation include rapid growth 4
Concerning changes that warrant immediate evaluation include bleeding or ulceration 4
Concerning changes that warrant immediate evaluation include pain or discomfort 4
Concerning changes that warrant immediate evaluation include development of nodules 4
Concerning changes that warrant immediate evaluation include color changes, especially darkening or variegation 1
Photography is recommended to document the baseline appearance and track changes over time 1

Complete excision should be considered for nevi with suspicious changes suggestive of malignant transformation 2
Complete excision should be considered for lesions in difficult-to-monitor locations 2
The decision for removal should take into account patient age and overall health 5
The decision for removal should take into account size and location of the nevus 5
The decision for removal should take into account family preference after thorough risk-benefit discussion 5

For suspicious lesions, complete excisional biopsy is preferred over shave biopsy to allow comprehensive histological assessment 2
Avoid partial removal of melanocytic nevi as this may result in pseudomelanoma (clinical and pathological picture resembling melanoma) 2
For confirmed melanoma arising in a congenital or atypical nevus, ensure removal of both the melanoma with appropriate margins and the entirety of the residual nevus 2

Patients with congenital nevi should be taught self-examination techniques 2
Higher-risk nevi may require visits every 3 months initially 4
After the first year, in the absence of concerning features, visit frequency can gradually decrease 4
A minimum of yearly dermatologist evaluation is appropriate for higher-risk nevi 4
Between visits, patients or caregivers should regularly inspect and palpate the nevus and report any concerning changes promptly 4