BATHING-TRUNK NEVI
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Is anyone aware of a protocol on babies with large bathing
trunk type nevi?  Has anyone been doing Q-Swithced or Yag of the lighter areas
without the deep dermal components?  I saw a consult today of a newborn whose
mother happens to work for my wife and the child has about 50% coverage of her
trunk with the usual satellite nevi everywhere else and I have already spoken
with the plastic people and they are going to see her.  Any of your suggestions
will be welcome.

L.J. Gregg MD. 
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The risk for melanoma occurring in these lesions is increased as we are 
all aware.  Unfortunately, a lot of the time the melanoma develops deep 
to the lesion or in the leptomeninges itself.  Therefore superficial 
treatment of a large CNN will probably do little to reduce the risk of 
melanoma.  The data for laser therapy of small CNN is not very 
convincing in my opinion.  Furthermore, if lightening of the 
lesion does occur, then repigmentation often ensues probably because the 
deeper cells have not been eliminated.  At present surgical excsion is 
usually recommended - often starting at 6 months of age.  However, 
patient follow up should be lifelong.  Finally, if there is midline or 
nuchal involvement, an MRI scan is recommended by some authorities.
         
Jason Rivers
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