The management of a child with a giant congenital melanocytic naevus (GCMN) is still one of the most controversial issues in paediatric dermatology. In the decision-making process aesthetic and psychosocial issues, risk of malignant transformation, and final cosmetic and functional outcome must be taken into consideration.
As the risk for developing melanoma in GCMN appears to be the most important in the first years of life, intervention must start as early as possible. Surgical excisions aimed at complete naevus removal do not always eliminate the risk of melanoma: it is often impossible to remove all naevus cells and there is still the risk for developing extracutaneous melanoma. Partial removal of superficially located naevus cells resulting in a more acceptable cosmetic outcome is another way of approaching these lesions and can be obtained by curettage, dermabrasion or laser therapy. On the basis of our personal experience in more than 50 patients, we advise removal of GCMN as early as possible. In the neonate curettage is our preferred treatment option as in most of our patients so-treated, good cosmetic and functional results were obtained. Moreover, by this technique an important reduction of the most active naevus cells with the highest proliferative activity is obtained. For lesions that can be excised in two or a maximum three procedures, we recommend serial excision. If this option is chosen, we strongly advise early intervention in the first months of life: taking advantage of the cutaneous laxicity of the skin results in better cosmetic outcome and in reduction of the number of interventions. We do not actually recommend laser treatment in the management of GCMN in paediatric patients, as this treatment may alter the biologic behaviour of residual naevus cells and repigmentation often occurs. Paediatricians have a crucial role in the outcome of these patients, as they can rapidly refer a newborn with a GCMN for optimal early intervention.