13. Outcomes of reconstruction congenital melanocytic nevi of the eyelids outcomes of reconstruction congenital melanocytic nevi of the eyelids
Main Article Content
Abstract
The study aimed to describe the outcomes after surgery to treat congenital melanocytic nevus (CMN) in the eyelid area. A descriptive analysis was conducted with 27 patients diagnosed with CMN in the eyelid area, with 19 CMN in upper eyelid and 21 CMN in lower eyelid. All patients underwent surgery. Of the 11 lesions in the eyelid area, 3 were ≤ ¼ the length of the eyelid, with 2 lesions closed directly and 1 excised and reconstructed using local flap. The 8 remaining lesions were > ¼ eyelash length; of these, 6 were reconstructed with local flaps, adjacent flaps, and 1 with a full-thickness skin graft, while 1 lesion underwent multiple excisions. A total of 36 lesions were treated in the eyelid and surrounding areas, with 30 out of 36 lesions received full thickness skin grafting. Early results were good in 40 surgeries (87%). Contracture occurred in 8/46 surgeries, all in the flap group. Distal outcome of the CMN in the eyelid area group were mostly good in terms of both function and aesthetics (7/9 cases). The group of CMN in the eyelid and surrounding areas were mostly good in terms of function (27/31 cases). Regarding aesthetics, the majority of eyelid margins were round (26/31 cases), however hyperpigmentation and/or stretched, overdeveloped, protruding scars were common (29/31 cases). After 6 months, secondary contraction of skin graft led to incomplete coverage of the eyeball in 4 cases. Local flaps and adjacent flaps reduced the shrinkage rate compared to early results in 1 case. Regarding local flap aesthetics, the adjacent flap showed a much greater advantage with 100% color similarity to the eyelid skin, thin scars in 87.5%, while 100% of the graft were darker than healthy skin, 26.7% thin scars. The majority of eyelid margins are round, soft in both patients using local flaps, adjacent flaps (87.5%) and grafts (81%). All patients reported satisfied or quite satisfied with their treatment. The results suggested early early evaluation and treatment of CMN in the eyelid area with excision lesion and recontruction may help prevent concerns about asthetic, function, and health-related issues for the patients. However, addressing aesthetics remain a challenge with CMN in the eyelid area and its surrounding. The choice of plastic method mainly depends on the size, location, the availability of nomal skin in adjacent anatomical units, with local flaps and adjacent flaps preferred when possible.
Article Details
Keywords
Congenital melanocytic nevus, the eyelids, surgery, serial excisions, local flaps, skin graft
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