The decision to have surgery has to be made on an individual basis, and very much depends on whether the surgeons think they can improve the appearance.
In cases of very large CMN, survery if often not possible. iN other cases, the following points should be considered:
- Many CMN will lighten spontaneously to at least some degree over a period of year. This can be monitored with repeat photographs.
- Surgery has not been shown to reduce the risk of melanoma in the child.
- Early surgery has not been shown to be advantageous. No routine surgery should take place before the age of 1 years.
- The site of the CMN is very important. For example, the child may get more benefit if a CMN on the face is removed, compared to one hidden on the scalp.
- The size of a CMN is very important – we have found that children with larger CMN were less pleased with the cosmetic result than those with small lesions which could be completely removed.
- The number of naevi is important, in particular if the child has a tendency to develop lots of new ones as this may reduce the benefit from removing some.
- Whether you want your child to take part in the decision, in which case it is better to wait until your child is old enough to consider the options available.
- What is involve in the type of surgery being offered – this will depend on the individual case.
If a CMN can be removed, for example by excision or serial excision (more than one operation but relatively straight-forward), the cosmetic benefits may easily outweigh the small risks associated with any operation. However, if a CMN is in a difficult place for removal, or if it is too large ever to be removed completely, then level of possible risk increases. It is very important in such cases, you should take time to decide about surgery, particularly to see if the CMN is lightening over time.
Laser therapy cannot be used to treat CMN. It will often lighten the colour, but this is a temporary phenomenon, and the CMN will gradually (or sometimes rapidly) grow pigment again. Sometimes it appears that the colour after repigmentation is lighter than it was at birth, but we now know that this is because in that individual the CMN was going to lighten anyway, and the final colour is connected the person’s own hair and skin colour, not to the colour it was at birth (or to any longterm help from laser). The same applies to dermabrasion or curettage, which are other superficial removal techniques.