1 International Journal of Medical and Dental Case Reports (2020), Article ID INS161 170320, 3 Pages CASE REPORT A case of giant hairy pigmented nevus of face – A case report Mayur J. Gawande, M. K. Gupta, Tejasvini Dehankar, Siddhesh Latke Department of Oral and Maxillofacial Surgery, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India Abstract The prophylactic excision of hairy nevus can be problematic due to the high esthetic nature of the afected area. Closure of the excisional defect by undermining the surrounding tissue followed by primary closure was questionable. A 20-year-old female patient reported to the Department of Oral and Maxillofacial Surgery at Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur having hairy nevus in the left cheek region undergoing excisional biopsy utilizing contemporary cosmetic surgery approaches was selected. The patient had successful removal of hairy nevus and primary closure was achieved with good cosmetic result. The use of contemporary cosmetic surgical approach for the excisional biopsy of hairy nevus by primary closure as an option for tissue expansion provides adequate surgical access, a cosmetically acceptable result, and is well-tolerated by patients. Keywords: Excision, hairy nevus, primary closer Correspondence: Mayur J. Gawande, Department of Oral and Maxillofacial Surgery, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Wanadongari Road, Hingana, Nagpur - 440 016, Maharashtra, India. Phone: +91-8793851956. Email: drmayurgawande@gmail.com Received 02 February 2020; Accepted 04 March 2020 doi: 10.15713/ins.ijmdcr.133 How to cite the article: Gawande MJ, Gupta MK, Dehankar T, Latke S. A case of giant hairy pigmented nevus of face – A case report. Int J Med Dent Case Rep 2020;7:1-3. Introduction Hairy nevus is a pigmented patch that resembles a garment or a bathing trunk. Although rare in occurrence these lesions have developed considerable attention due to its cosmetic consideration and relatively high (10–20%) risk of its malignant transformation congenital pigmented nevi have a incidence rate of 2–3% in newborns, a few are larger than 3–4 cm. [1] In the review of literature, we found that the nevi were classifed depending on its size as small, large, and giant. Pers in 1963 described “giant” as palm size on the face. [2] Greeley in 1965 described giant as 144 square inches or more. [2] Pilney et al. considered a lesion giant when it could not be closed primarily after complete excision. [3] It is important to distinguish between congenital as opposed to the ones we develop with age because congenital nevi are thought to have a small chance of becoming malignant. Quaba and Wallace quotes a 8.52% incidence of melanoma developing in nevi larger than 2% of body surface area, the transformation of nevi into malignant melanoma is now an established fact. [4] Prophylactic complete excision of nevi is supported by some of the fndings from studies conducted by Dellon et al. and Rhodes et al. on malignant potential of giant pigmented nevus. [5,6] Management of giant hairy nevus of the face can be a challenging task even for an experienced Oral and Maxillofacial Surgeon as it requires a very high standard of skills and also concern for cosmetic results from the patient and parental side. This study gives a broader aspect of treatment modalities which were used to achieve better cosmetic results. Case Report A 20-year-old female patient with hairy nevus in the left cheek region reported to the Department of Oral and Maxillofacial Surgery at Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur. The lesion extended from tragus of the left ear to inferior border of mandible in the left angle region, the lesion measured 5 cm × 3 cm in size [Figure 1]. Skin incision was made after which dissection was performed, care was taken to stay deep to the lesion and dissect out beyond it to improve access. The remainder of subcutaneous fap undermining was completed and tension-free primary closure was achieved. In addition, all the possible eforts were taken to avoid any kind of injury to facial nerve branches, especially when nerve becomes more superfcial as one proceeds anterior to the parotid gland [Figure 2].