Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letters in Response to Previous Publication
87 (
6
); 837-838
doi:
10.25259/IJDVL_461_2021
pmid:
34245521

Letter in response to the article: “A retrospective case series of ten patients with malignant melanomas arising from small- and medium-sized congenital melanocytic nevi in South Koreans”

Department of Plastic and Reconstructive Surgery, “Santa Maria della Misericordia” University Hospital, Udine, Italy
Institute of Dermatology, “Santa Maria della Misericordia” University Hospital, Udine, Italy

Corresponding author: Dr. Nicola Zingaretti, Department of Plastic and Reconstructive Surgery, “Santa Maria dellaMisericordia” University Hospital, Udine, Italy. zingarettin@gmail.com

Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Zingaretti N, Albanese R, Errichetti E, Stinco G, Caputo GG, Parodi PC. Letter in response to the article: “A retrospective case series of ten patients with malignant melanomas arising from small- and medium-sized congenital melanocytic nevi in South Koreans.” Indian J Dermatol Venereol Leprol 2021;87:837-8.

Sir,

We read with great interest the paper recently published in your esteemed Journal by Kim et al.1 In their retrospective analysis, the authors showed a melanoma incidence rate of 2.7% in a group of 377 small (<1.5 cm) and medium (1.5–19.9 cm) congenital melanocytic nevi followed over a period of 6.5 years. This study emphasizes a possible underestimation of the risk of malignant transformation of such lesions, especially those of medium size, which showed a higher incidence rate compared to small congenital melanocytic nevi (2.7% vs. 2.2%). Indeed, based on available literature data, the risk of malignant transformation of small/ medium congenital melanocytic nevi would be quite lower with an overall incidence of melanoma associated with this type of nevi being less than one percent (0–1.3%).2

Of note, the reasons underlying the discrepancy between the study by Kim et al. and previous data have not been addressed by the authors. In our opinion, one of the explanations could be the lack of prospective/retrospective analyses on small/ medium congenital melanocytic nevi following patients in adulthood as most of the published longitudinal studies focused on young subjects with no adult age monitoring. This is a significant bias since small/medium congenital melanocytic nevi-associated melanoma tends to spare prepubertal children and occur during adulthood. This is consistent with data observed in the analysis by Kim et al., in which the mean age of patients with malignant transformation was 49.2 years. In addition, the likelihood of developing melanoma in small/ medium congenital melanocytic nevi has been often evaluated without stratifying the risk between these nevi or according to the size in the previous studies. This is another potential bias as it is possible that the risk of melanoma in such nevi might vary between small and medium lesions but also based on the size in the context of medium congenital melanocytic nevi with larger lesions having a greater incidence.

In our opinion, the study by Kim et al. and the above-mentioned biases concerning existing literature data should stimulate researchers to set prospective analyses on patients with small/medium congenital melanocytic nevi including adult age monitoring as it is possible there is an underestimation of melanoma risk in such lesions, especially those of greater size. Only a better knowledge on the lifetime risk of malignant transformation may ensure a correct management of these nevi.

In this regard, two main strategies have been suggested for non-suspicious lesions, that is, periodic clinical and/ or dermoscopic monitoring and prophylactic excision.3 Regarding the latter option, the ideal timing would be before the age of 11 since this has been reported as the minimum age of small/medium congenital melanocytic nevi-associated melanoma development by several studies. However, some surgical factors need to be taken into account about the optimal timing of excision to achieve the best possible esthetic outcome, mainly including lesions size and location. While the impact of the former factor is intuitive, we would like to make a specific consideration on the latter variable. The projected adult size is different in relation to the considered anatomical region. As suggested by Krengel et al.,4 from birth to adulthood, the area of the head grows by a factor of 2.8, trunk and upper limbs by a factor of eight and lower limbs by a factor of 12. Therefore, the surgical excision should always be performed considering the growth potential of the region.

The lesions located on/near joints or genital area are the most challenging ones as their excision might result in scar contractures with consequent possible functional problems, pain and esthetics issues.

In our experience, the direct closure must always be performed whenever possible. In addition, the incision should be made perpendicular to the direction of growth so as to change as little as possible over the years. The skin graft should be made at full thickness so as to retract as little as possible.

Finally, the flaps should be harvested considering the growth lines and the anatomical region of the donor site.

The growth phase of the patient which begins and ends earlier in women (12–16 years) than in men (14–18 years) could be defined “dynamic phases” in the surgical treatment. This phase is typified by a very accelerated growth and, therefore, it is not advisable to defer surgery.

Declaration of patient consent

Patient’s consent not required as there are no patients in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

  1. , , , , , . A retrospective case series of 10 patients with malignant melanomas arising from small-and medium-sized congenital melanocytic nevi in South Koreans. Indian J Dermatol Venereol Leprol. 2021;87:293-7.
    [CrossRef] [PubMed] [Google Scholar]
  2. , , , , , , et al. Melanoma in congenital melanocytic naevi. Br J Dermatol. 2017;176:1131-43.
    [CrossRef] [PubMed] [Google Scholar]
  3. , , . Congenital melanocytic nevi: Treatment modalities and management options. Semin Cutan Med Surg. 2007;26:231-40.
    [CrossRef] [PubMed] [Google Scholar]
  4. , , , , . New recommendations for the categorization of cutaneous features of congenital melanocytic nevi. J Am Acad Dermatol. 2013;68:441-51.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views
4,626

PDF downloads
1,151
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections