Case report
A nonepidermal, primary malignant melanoma arising in a giant congenital melanocytic nevus 40 years after partial surgical removal

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Case report

A previously healthy 44-year-old woman presented with a 2-week history of a pruritic nodule on her left forearm. She had been followed up as a child for a GCMN involving her left arm, extending from her shoulder to her wrist. She also had satellite nevi on her buttocks and lower extremities. In 1964, when the patient was 5 years old, she had the first of multiple staged excisions of the GCMN under general anesthesia (Fig 1). The nevus was excised from the wrist to approximately 10 cm above the

Discussion

GCMN can often be a source of anxiety for patients and clinicians. Not only are patients frequently affected psychologically by the cosmetically disfiguring nature of these lesions, but they also have a well-established increased risk for developing melanoma. Approximately 60% of all melanomas occurring in the first decade of life arise from GCMN.4 Early surveillance and detection is critical. Unfortunately, there is no current consensus on the most appropriate strategy for evaluation and

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Cited by (30)

  • Characteristics, treatment, and survival of invasive malignant melanoma (MM) in giant pigmented nevi (GPN) in adults: 976 cases from the National Cancer Data Base (NCDB)

    2016, Journal of the American Academy of Dermatology
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    A low threshold for histologic evaluation of any suspicious lesions in these patients given their increased risk is recommended, and although we are unable to determine the malignant potential of a pre-existing GPN, prophylactic excision has been recommended when feasible, particularly if the patient considers the lesion to be cosmetically undesirable. Monitoring should still be continued in patients with resected GPN, as cases have been reported of MM developing deeper in or around those sites.9,24,25 In conclusion, MM in GPN in adults is a rare disease, accounting for 0.2% of all melanomas collected by the NCDB.

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    2009, Weedon's Skin Pathology: Third Edition
  • Controversial issues in congenital nevi

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  • Large or multiple congenital melanocytic nevi: Occurrence of cutaneous melanoma in 1008 persons

    2005, Journal of the American Academy of Dermatology
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    He is currently doing well at age 43. Similar occurrences of melanoma of a nonepidermal origin in those with giant nevi have been reported.20,21 Development of cutaneous melanoma during pregnancy occurred once in our group.

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Funding sources: None.

Conflicts of interest: None identified.

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