Vol.:(0123456789) 1 3 Pediatric Surgery International https://doi.org/10.1007/s00383-020-04633-z ORIGINAL ARTICLE Surgical treatment of children and youth with congenital melanocytic nevi: self‑ and proxy‑reported opinions Kathrin Neuhaus 1,3  · Markus Landolt 2,3  · Miliana Vojvodic 1,3  · Sophie Böttcher‑Haberzeth 1,3  · Clemens Schiestl 1,3  · Martin Meuli 1,3  · Ornella Masnari 2,3 Accepted: 19 February 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020 Abstract Purpose The role of surgery in the management of congenital melanocytic nevi (CMN) is controversial. Data on surgical outcomes and predictors of satisfaction remain scarce. Methods An online survey was employed following worldwide recruitment of youth aged 14–25 years (n = 44) and par- ents of children ≤ 18 years (n = 249) with CMN to query patterns of treatment and satisfaction with and opinions about the benefts of surgery. Results In proxy-reports, 121 of 249 (49%) and in self-reports 30 of 44 (75%) participants underwent CMN excision. The most common reasons for surgery were psychosocial determinants, aesthetic improvement, and melanoma risk reduction. The overall satisfaction with surgical management was good, although no predictors for satisfaction could be identifed. Higher current age of the child was found to predict decision regret in proxy-reports. Most participants indicated that having a scar is more socially acceptable than a CMN. Opinions difered on whether surgery should be deferred until the child is old enough to be involved in the decision-making process. Conclusions Whether and when to perform surgery in children with CMN is a multifaceted question. Awareness of common concerns as well as risks and benefts of surgery are essential to ensure critical refection and balanced decision-making. Keywords Melanocytic nevi · Surgery · Outcome · Patient satisfaction · Children Introduction Congenital melanocytic nevi (CMN) are commonly seen as brown or black moles that present at birth or during the frst few weeks of postnatal life. They represent neural crest-derived benign clonal proliferations of melanocytes [1]. Incidences range from 1 to 2% for CMN of any size and up to 1 in 20,000 for giant CMN with a projected adult size of ≥ 20 cm in diameter [2–5]. CMN morphology and appearance are highly variable and they may occur as a sin- gle lesion or be accompanied by other CMN [4, 5]. Most CMN are, despite their life-long presence, clinically uncom- plicated. However, some patients experience mild to moder- ate physical symptoms including pruritus or pain due to skin fragility and a few patients sufer from severe and potentially life-threatening complications such as the development of melanoma or central nervous system pathology. The incidence of melanoma in CMN patients was histori- cally overestimated due to small sample sizes and reporting bias [6]. Based on the presumed high risk of malignancy and the assumption that surgery would reduce this risk, surgery remained the mainstay of treatment for decades [3, 7]. Recent and more reliable data showed that the over- all melanoma risk for CMN patients is signifcantly lower than previously thought, ranging between 0.7 and 3.1% [6–8]. This new evidence fueled a paradigm shift in CMN management whereby routine surgery has become increas- ingly scrutinized [9]. Furthermore, surgery was not found to reduce the risk of malignancy, but rather to adversely * Kathrin Neuhaus kathrin.neuhaus@kispi.uzh.ch 1 Division of Plastic and Reconstructive Surgery, Department of Surgery, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland 2 Department of Psychosomatics and Psychiatry, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland 3 Children’s Research Center, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland