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BACKGROUND: Multiple primary melanoma (MPM) is a diagnostic challenge even with ancillary imaging technologies available to dermatologists. In selected patients' phenotypes, the use of imaging approaches can help better understand lesion characteristics, and aid in early diagnosis and management. METHODS: Under a 5-year prospective single-center follow-up, 58 s primary melanomas (SPMs) were diagnosed in two first-degree relatives, with fair skin color, red hair, green eyes, and personal history of one previous melanoma each. Patients' behavior and descriptive demographic data were collected from medical records. The information on the first two primary melanomas (PMs) were retrieved from pathology reports. The characteristics of 60 melanomas were collected from medical records, video dermoscopy software, and pathology reports. Reflectance confocal microscopy (RCM) was performed prior to excision of 22 randomly selected melanomas. RESULTS: From February 2018 to May 2023, two patients underwent a pooled total of 214 excisional biopsies of suspect lesions, resulting in a combined benign versus malignant treatment ratio (NNT) of 2.0:1.0. The number of moles excised for each melanoma diagnosed (NNE) was 1.7:1.0 and 6.9:1.0 for the female and male patient respectively. The in-situ melanoma/invasive melanoma ratio (IIR) demonstrated a higher proportion of in-situ melanomas for both patients. From June 2018 to May 2023, a total of 58 SPMs were detected by the combination of total body skin exam (TBSE), total body skin photography (TBSP), digital dermoscopy (DD), and sequential digital dermoscopy imaging (SDDI) via comparative approach. The younger patient had her PM one month prior to the second and third cutaneous melanomas (CMs), characterizing a case of synchronous primary CM. The male older relative had a total of 7 nonsynchronous melanomas. CONCLUSIONS: This CM cohort is composed of 83.3% in-situ melanoma and 16.7% invasive melanoma. Both patients had a higher percentage of SPM with clinical nevus-like morphology (84.5%), global dermoscopic pattern of asymmetric multiple component (60.3%) and located on the lower limbs (46.6%). When RCM was performed prior to excision, 81% of SPM had features suggestive of malignancy. As well, invasive melanomas were more frequent in the lower limbs (40%). In the multivariate model, for the two high-risk patients studied, the chance of a not associated with nevus ("de novo") invasive SPM diagnosis is 25 times greater than the chance of a diagnosis of a nevus-associated invasive SPM.

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Introdução: Com o avanço da análise digital de imagens, análises preditivas e métodos de aprendizagem de máquina, surgiram estudos referentes ao uso da inteligência artificial nos exames de imagem como a dermatoscopia. Objetivo: Construção, teste e implementação de uma rede neural artificial baseada em características de imagens dermatoscópicas. Métodos: Foram incluídas 1949 imagens de nevos melanocíticos e melanomas, tanto de arquivos dos autores, quanto de bancos de imagens dermatoscópicas disponíveis na internet, e desenvolvidas rotinas e plugins para a extração de 58 características aplicadas a um algoritmo de construção de rede neural multicamadas. Quarenta imagens aleatórias foram também avaliadas por 52 dermatologistas e os acertos comparados. Resultados: O treinamento e o teste da rede neural obtiveram uma porcentagem correta de classificação de 78,5 e 79,1%, respectivamente, com uma curva ROC abrangendo 86,5% da área. A sensibilidade e especificidade dos dermatologistas foi de 71,8 e 52%. Para as mesmas imagens e um ponto de corte de 0,4 (40%) do valor de saída, o aplicativo obteve valores de 62 e 56%, respectivamente. Conclusões: Modelos de rede neural multicamada podem auxiliar na avaliação dermatoscópica de nevos melanocíticos e melanomas, quanto ao diagnóstico diferencial entre eles.

Introduction: With the advancement of digital image analysis, predictive analysis, and machine learning methods, studies have emerged regarding the use of artificial intelligence in imaging tests such as dermoscopy. Objective: Construction, testing, and implementation of an artificial neural network based on characteristics of dermoscopic images. Methods: 1949 images of melanocytic nevi and melanomas were included, both from the authors' files and from dermoscopic image banks available on the internet, and routines and plugins were developed to extract 58 features applied to a multilayered neural network construction algorithm. Also, 52 dermatologists assessed 40 random images and compared the results compared. Results: The training and testing of the neural network obtained a correct percentage of classification of 78.5% and 79.1%, respectively, with a ROC curve covering 86.5% of the area. The sensitivity and specificity of dermatologists were 71.8% and 52%. For the same images and a cutoff point of 0.4 (40%) of the output value, the application obtained 62% and 56% values, respectively. Conclusions: Multilayer neural network models can assist in the dermoscopic evaluation of melanocytic nevi and melanomas regarding the differential diagnosis between them

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A discromia azul das unhas possui vários diagnósticos diferenciais. Crescimento da lesão, distrofia ungueal associada e extensão periungueal requerem avaliação para excisão cirúrgica. Mulher, 27 anos, apresentava mancha azulada, semicircular, ocupando cerca de 50% da lúnula, sem alteração da lâmina suprajacente, com pequena alteração da porção distal da unha, com camadas do tipo "onicosquizia localizada", sem história prévia de trauma ou sangramento. Realizada avulsão parcial da placa e biópsia excisional por saucerização da lesão fortemente pigmentada. O exame histopatológico foi compatível com nevo azul. Sugere-se que, neste caso, o nevo se situasse em posição submatricial, não interferindo, portanto, na coloração da lâmina ungueal

Blue nail dyschromia has several differential diagnoses. Lesion growth, associated nail dystrophy, and nail extension require evaluation for surgical excision. We report the case of a 27-year-old woman presenting a bluish, semicircular stain, occupying about 50% of the lunula. The patient presented no changes in the overlying lamina, small alteration of the distal nail portion, localized onychoschizia-type layers, and no previous trauma or bleeding history. We performed partial avulsion of the plaque and shave biopsy, evidencing an intensely pigmented lesion. Histopathological examination was compatible with blue nevus. In this case, the nevus should be located in the sub-matricial position, thus not interfering with the nail plate color

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Malignant melanoma represents the most aggressive type of skin cancer. Modern therapies, including targeted agents and immune checkpoint inhibitors, have changed the dismal prognosis that characterized this disease. However, most evidence was obtained by studying patients with frequent subtypes of cutaneous melanoma (CM). Consequently, there is an emerging need to understand the molecular basis and treatment approaches for unusual melanoma subtypes. Even a standardized definition of infrequent or rare melanoma is not clearly established. For that reason, we reviewed this challenging topic considering clinical and molecular perspectives, including uncommon CMs-not associated with classical V600E/K BRAF mutations-malignant mucosal and uveal melanomas, and some unusual independent entities, such as amelanotic, desmoplastic, or spitzoid melanomas. Finally, we collected information regarding melanomas from non-traditional primary sites, which emerge from locations as unique as meninges, dermis, lymph nodes, the esophagus, and breasts. The aim of this review is to summarize and highlight the main scientific evidence regarding rare melanomas, with a particular focus on treatment perspectives.

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Introducción:Los Nevos Melanocíticos Congénitos (NMC) son lesiones cutáneas que frecuentemente están presentes desde el nacimiento, sin embargo,la presencia de un NMC gigante mayor a 20 cm es infrecuente, motivo de presentación del caso. Caso: Niño de 2 años y 5 meses, quien presentó Nevos congénitas de diferente diámetro dispersos en toda el área de la piel, siendo el más grande uno de color oscuro en el área de tórax posterior en línea media dorsal, abollonada que se eleva de la piel e inicia desde el occipucio y se prolonga por la línea media hasta llegar a la región sacra y glúteos, cubre hombros de forma triangular inversa con diámetros de 27 por 25 centímetros. Se acompañade numerosos nevos satelitales de 3 milímetros hasta 15 centímetros. La presencia de dos neurofibromasenlos dedos. Evolución: Una interconsulta a Neurología Pediátrica concluyó en un examen neurológico sin alteración, el estudio de Resonancia Magnética Nuclear Cerebral y del canal espinal,fueron normales, así como los exámenes complementarios de biometría hemática, química sanguínea, perfil hepático, perfil tiroideoy eco abdominal. La biopsia de piel reportó un patrón histológico de Nevo Melanocítico. Debido a la extensión de la lesión se decidió la observación. El prurito fue tratado sintomáticamente. Conclusión:El Síndrome del Nevo Melanocítico Congénito se asocia con múltiples hallazgos fenotípicos clásicos, dentro de los cuales se encuentran patrones de pigmentación que ocupan las líneas de Blaschko, neurofibromas y múltiples melanomas satélites. Su diagnóstico es clínico y para su tratamiento se requieren procedimientos quirúrgicos a consideración de la extensión de la lesión. El manejo integral de manera interdisciplinaria es fundamental en su tratamiento

Introduction: Congenital Melanocytic Nevi (CMN) are skin lesions that are frequently present from birth, however, the presence of a giant CMN greater than 20 cm is infrequent, reason for the presentation of the case. Case: A boy of 2 years and 5 months, who presented congenital nevi of different diameter scattered throughout the skin area, the largest being a dark-colored one in the posterior thorax area in the mid-dorsal line, embossed that rises from the skin and starts from the occiput and extends through the midline until it reaches the sacral region and buttocks, it covers shoulders in an inverse triangular shape with diameters of 27 by 25 centimeters. It is accompanied by numerous satellite nevi from 3 millimeters to 15 centimeters. The presence of two neurofibromas on the fingers. Evolution: A consultation with Pediatric Neurology concluded in a neurological examination without alteration, the study of Brain Nuclear Magnetic Resonance and of the spinal canal, were normal, as well as the complementary tests of hematic biometry, blood chemistry, liver profile, thyroid profile and abdominal echo . The skin biopsy reported a histological patternof Melanocytic Nevus. Due to the extent of the injury, observation was decided. The pruritus was treated symptomatically. Conclusion: Congenital Melanocytic Nevus Syndrome is associated with multiple classic phenotypic findings, among which are pigmentation patterns that occupy Blaschko's lines, neurofibromas and multiple satellite melanomas. Its diagnosis is clinical and its treatment requires surgical procedures, taking into account the extent of the lesion. Comprehensive management in an interdisciplinary manner is essential in its treatment

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Abstract Spitz nevus is a benign melanocytic lesion, which presents in several ways: solitary, agminated, or disseminated. The disseminated variant is uncommon; it may have a rapid evolution (the eruptive form) and be difficult to manage. This report presents the case of a 24-year-old patient with multiple papules on his limbs, which had appeared four years previously. On physical examination, 120 pink and skin-colored papules were seen, which under dermoscopy were observed to be homogeneous, pink vascular lesions. Histopathologic study revealed epithelioid cells arranged in groups or singly in the dermis and dermo-epidermal junction. They were HMB-45 positive in the superficial dermis, and Ki-67 < 1%. Given these findings, a diagnosis of eruptive disseminated Spitz nevi was made.

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Pacientes com nevo melanocítico congênito gigante possuem maior risco de desenvolver melanoma. Após o primeiro diagnóstico de melanoma, há também uma maior incidência de melanomas subsequentes em um mesmo paciente. No entanto, a terapêutica ideal para esta forma de nevo ainda é controversa. É relatado o caso de um paciente com nevo congênito gigante associado a melanoma múltiplo sincrônico e o tratamento proposto.

Patients with giant congenital melanocytic nevus are at higher risk of developing melanoma. After the first diagnosis of melanoma, there is also a higher incidence of subsequent melanomas in the same patient. However, the ideal therapy for this type of nevus is still controversial. We report the case of a patient with giant congenital nevus associated with multiple synchronous melanomas and the proposed treatment

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Spitz nevus is a benign melanocytic lesion, which presents in several ways: solitary, agminated, or disseminated. The disseminated variant is uncommon; it may have a rapid evolution (the eruptive form) and be difficult to manage. This report presents the case of a 24-year-old patient with multiple papules on his limbs, which had appeared four years previously. On physical examination, 120 pink and skin-colored papules were seen, which under dermoscopy were observed to be homogeneous, pink vascular lesions. Histopathologic study revealed epithelioid cells arranged in groups or singly in the dermis and dermo-epidermal junction. They were HMB-45 positive in the superficial dermis, and Ki-67<1%. Given these findings, a diagnosis of eruptive disseminated Spitz nevi was made.

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Resumen: Los nevos melanocíticos congénitos son una proliferación melanocítica benigna presente al nacimiento o que surgen en los primeros 2 o 3 años de vida. Habitualmente se clasifican, según su tamaño, en pequeños, medianos y grandes. Su importancia radica en el potencial riesgo de desarrollar melanoma, en la repercusión que tienen en la calidad de vida de quien los padece y en la asociación con disrafismo y tumores del sistema nervioso central. A mayor tamaño, mayor riesgo de desarrollar melanoma en el nevo o fuera de él. Describiremos las características epidemiológicas, clínicas dermatoscópicas y revisaremos el manejo y seguimiento de los nevos congénitos.

Summary: Congenital melanocytic nevi are a benign melanocytic proliferation present either from birth or during the first 2 or 3 years of life. They are usually classified according to size as: small, medium and large. Their importance lies on the potential risk of developing melanoma, on the impact they have on the patient's quality of life and on its association with dysraphism and tumors of the central nervous system. The larger the size of the nevi, the higher the risk of developing melanoma inside or outside the nevus. We will describe the epidemiological and dermatoscopic clinical characteristics and review the management and follow-up of congenital nevi.

Resumo: Os nevos melanocíticos congênitos são uma proliferação melanocítica benigna presente desde o nascimento ou durante os primeiros 2 ou 3 anos de vida. Eles são geralmente classificados de acordo com o seu tamanho como: pequenos, médios ou grandes. Sua importância está no risco potencial de desenvolver melanoma, no impacto que eles têm na qualidade de vida do paciente e na sua associação com disrafismo e tumores do sistema nervoso central. Quanto maior o tamanho dos nevos, maior o risco de desenvolver melanoma dentro ou fora do nevo. Descreveremos as características clínicas epidemiológicas e dermatoscópicas dos nevos congênitos e revisaremos o seu gerenciamento e acompanhamento.

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Abstract Onychocytic matricoma is a newly described tumor of the nail matrix. Clinically, it presents with localized thickening of the nail plate and melanonychia. Histologically, it represents a benign acanthoma of onychocytes. There are 8 cases reported in the literature. A 12-year-old girl presented with localized melanonychia and concurrent thickening of the nail plate restricted to the area of pigmentation affecting the right thumb, with no history of trauma or pain. We report a case of this rare tumor occurring in late childhood and provide a comprehensive review of its clinical presentation and differential diagnosis. Both clinicians and dermatopathologists should be aware of the presentation of onychocytic matricoma and include it in their scope of diagnosis of longitudinal nail bands.

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BACKGROUND: Head and neck mucosal melanomas (MMs) are rare tumors with adverse outcomes and poorer prognoses than their more common cutaneous counterparts (cutaneous melanomas-CMs). Few studies have compared the expression of mitochondrial dynamic markers in these tumors. This study aimed to assess the correlations of mitochondrial markers with melanoma progression and their potential as predictors of lymph node involvement and distant metastasis. METHODS: Immunohistochemistry against anti-mitochondrial (AMT), dynamin-related protein 1 (DRP1), mitochondrial fission protein 1 (FIS1), mitofusin-1 (MFN1), and mitofusin-2 (MFN2) antibodies was performed in 112 cases of head and neck CM and MM. A Cox regression multivariate model was used to assess the correlation of AMT, FIS1, and MFN2 expressions considering the risk for nodal and distant metastasis. RESULTS: All markers studied presented higher staining in tumor cells than normal adjacent tissues. Higher mitochondrial content was observed in MM than in CM, and it was significantly associated with nodal metastasis in oral melanomas. Both FIS1 and DRP1 expressions were related to advanced Clark's levels in CM, and they were overexpressed in oral melanomas. Moreover, increased immunoexpression of MFN2 was significantly associated with a higher risk of metastasis in CM, and it was also overexpressed in sinonasal melanomas. CONCLUSIONS: Our results suggest that mitochondrial fission and fusion processes can play an important role during multiple stages of tumorigenesis and the development of nodal and distant metastasis in cutaneous and mucosal melanomas.

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Abstract: Several reports have demonstrated difficulties and lack of agreement in the histopathological diagnosis of particular melanocytic lesions, with problems in their management. A histogenetic approach to the study of these lesions originated the following classification: 1. superficial atypical proliferation significance; 2. melanocytic tumor of uncertain potential; 3. pigmented epithelioid melanocitoma of uncertain potential; 4. microinvasive radial growth phase of uncertain potential. The terminology remains controversial, reflecting the uncertainty of the diagnosis and the biological potential of these atypical melanocytic lesions.

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Melanomas are highly aggressive tumours derived from melanocytes, which occur most commonly in the skin. Occasionally, these tumours may appear in oral and sinonasal mucous membranes. In this study, we performed a comparative analysis of the Phosphorylated Akt1 (p-Akt1) expression in 144 patients affected by cutaneous (CM), 34 oral cavity (OM), and 31 sinonasal melanomas (SNM). Similar to the metastatic cutaneous melanomas, p-Akt1 was overexpressed in 17/34 of the oral cavity and 20/31 of the sinonasal melanomas. In addition, the p-Akt1-nuclear expression was associated with poorer cancer-specific survival in cutaneous (P < .0001), oral (P < .0001), and sinonasal (P = .001) melanomas. Multivariate analysis showed p-Akt1 to be an independent prognostic marker in oral (P = .041) and sinonasal (P < .0001) melanomas patients. In conclusion, p-Akt1 overexpression is an independent prognostic marker in mucosal melanomas and is significantly up-regulated in sinonasal melanomas. As both mucosal and metastatic cutaneous melanomas showed high frequency of p-Akt1 expression, these findings suggest that mucosal melanomas have a biological behaviour, similar to the aggressive cutaneous melanomas.

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RESUMO Objetivo: Descrever a evolução clínica do nevo de Spitz, desde sua característica inicial plana até o aparecimento de uma superfície irregular, nodular e avermelhada e a conduta perante essas alterações. Descrição do caso: Criança do sexo feminino, fototipo II, com um pequeno nevo congênito na perna esquerda e outros pequenos nevos adquiridos. Paciente passou por avaliações anuais clínicas e dermatoscópicas para controle entre 3 e 7 anos de idade, quando um desses nevos, localizado na coxa esquerda, apresentou crescimento rápido. A hipótese clínica foi nevo de Spitz, com indicação de remoção cirúrgica com margem de segurança e posterior análise anatomopatológica. Considerando a idade da paciente e os aspectos clínicos e histológicos, a lesão foi diagnosticada como nevo de Spitz. Comentários: Uma lesão de padrão dermatoscópico globular e menor que 5 mm permitia acompanhamento clínico, porém a hipercromia, a estética local, o crescimento rápido, a possibilidade de trauma na região e os riscos de transformação maligna na puberdade nortearam a decisão de remoção total e posterior acompanhamento para monitorar qualquer recidiva.

ABSTRACT Objective: To report the clinical evolution and handling of a Spitz nevus, from its initial flat feature to becoming an irregular, nodular, reddish lesion. Case description: Female child, phototype II, with a small congenital nevus on the left lower limb and other sustained small nevi. The patient went through annual clinical and dermoscopic evaluations between the ages of three and seven, period during which the nevi located on the left thigh grew rapidly. The clinical hypothesis was Spitz nevus, with indication of surgical removal with a safety margin and anatomopathological study. Considering patient's age and clinical/histological aspects, the diagnosis of Spitz nevus was confirmed. Comments: Initial globular pattern and size under 5 mm upon dermoscopy allowed clinical follow-up. However, onset of hyperchromia and rapid growing of the lesion, along with aesthetic concerns, possibility of trauma in the region, and risk of malignancy at puberty guided the decision of total resection and follow-up for recurrence.

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Fundamento: la melanosis neurocutánea es un trastorno congénito no hereditario que se caracteriza por la asociación de nevus pigmentados múltiples o de gran tamaño y una excesiva proliferación de melanocitos en el sistema nervioso central. Por lo general los síntomas neurológicos son de temprana aparición en la etapa de lactante con presencia de convulsiones de difícil control, al crear un pronóstico reservado. Objetivo: presentar un caso con diagnóstico clínico de melanosis neurocutánea con manifestaciones neurológicas como son las convulsiones desde la etapa de lactante. Caso clínico: paciente masculino que nace con mancha melánica gigante que se extiende desde el tórax al abdomen, región inguinal, genital y miembros inferior como pieza de vestir. En la región posterior de espalda, comienza en ambos flancos, región sacra hasta la mitad de ambas piernas, aparecen convulsiones al mes de nacido. Al continuar la aparición de manchas hiperpigmentada por todo el cuerpo, que ya al año de vida son mayores más oscuras acompañadas de vello grueso, con crisis epilépticas refractaria al tratamiento. Conclusiones: esta enfermedad que se produce por el aumento de melanina a la piel y el sistema nervioso central, requiere una vigilancia de las lesiones dérmicas y un control de las crisis convulsivas. Se considera importante el seguimiento del neurodesarrollo de forma multidisciplinario para intervención oportuna si fuera necesario.

Background: neurocutaneous melanosis is a non-hereditary congenital disorder characterized by the association of multiple or large pigmented nevus and an excessive proliferation of melanocytes in the central nervous system. Neurological symptoms are usually of early onset in the infant stage with convulsions of difficult control, making the forecast reserved. Objective: to present a case with clinical diagnosis of neurocutaneous melanosis with neurological manifestations such as seizures from the infant stage. Clinical case: a male patient born with a giant melanoma stain that extends from the thorax to the abdomen, inguinal region, genital and lower limbs as a dressing. In the posterior region of the back, it begins in both flanks, sacral region until the misty of both legs, presenting convulsions at one month old. Continuing the appearance of hyperpigmented spots all over the body, which at the age of life are larger darker accompanied by thick hair, with epileptic seizures refractory to treatment. Conclusions: this disease that is produced by the increase of melanin to the skin and the central nervous system requires a monitoring of dermal lesions and a control of seizures, considering the importance of neurodevelopmental follow-up in a multidisciplinary way for timely intervention if necessary.

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Abstract: Lentigo maligna has an extensive and neoplastic character. It typically progresses slowly and may eventually develop into an invasive melanoma, which is called lentigo maligna melanoma. Ocular melanoma is the second most common type of melanoma. The uvea is the most common site of origin of ocular melanomas, while conjunctival melanoma accounts for about 1-5% of cases. In this article, we describe a rare case of synchronic conjunctival melanoma and lentigo maligna on the face.

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Melanoma is one of the most aggressive and worse prognosis tumors. Early diagnosis is essential to offer therapeutic alternatives. Presentation may be variable. Within these the amelanotic melanoma form. We present the case of a patient treated at the ¨Hospital Regional de Talca¨, with an unclear diagnosis of melanoma at a first moment given the characteristics and location of the lesion, the history of trauma and the patient comorbidities, which after biopsy and immunohistochemical analysis, the diagnosis of amelanotic melanoma is possible.

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Abstract The concern about malignant skin neoplasms leads to the excision of smaller lesions. This study on small melanocytic lesions aims to evaluate the range of possible histopathological diagnoses, describe histopathological aspects, and assess the usefulness of serial histological sections. We performed a cross-sectional descriptive histopathological study examining 76 pigmented skin lesions up to 6 mm in diameter. Histopathological diagnoses included atypical melanocytic nevi (n=38), common melanocytic nevi (n=18), atypical lentiginous melanocytic hyperplasia with architectural features of atypical melanocytic nevi (n=7), lentigo simplex (n=2), and malignant melanoma (n=1). Ten cases were non-diagnostic. Cytological atypia was not an exclusive finding of atypical lesions. Examination of serial sections did not change histopathological impression. Early detection of malignant melanoma is important, but clinical and dermoscopy exams may be leading to the resection of a great number of benign lesions. Strict attention to histopathological criteria results in a large number of non-diagnostic cases.

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Abstract: Background: Large congenital melanocytic nevus (LCMN) is considered a risk factor for melanoma, although the magnitude of this risk is controversial. Objective: To evaluate the risk of melanoma development in patients with LCMN seen at a dermatology referral center in Brazil during a twelve-year period. To the best of our knowledge, there are no published similar studies on large congenital melanocytic nevus in South America. Methods: Our prospective cohort included only patients with congenital nevi ≥20cm. The cumulative risk of developing melanoma and the standardized morbidity ratio were calculated for patients followed up prospectively for at least 1 month. Results: Sixty-three patients were enrolled in this study. One patient who developed melanoma prior to enrollment was excluded, and five were eliminated because of insufficient follow-up time. Mean follow-up for the remaining 57 patients was 5.5 years (median 5.2 years). Median age of entry into the study was 2.6 years. Most patients (75.4%) underwent only clinical observation. Melanomas occurred in 2 (3.5%) patients. Five-year cumulative risk for melanoma was 4.8% (95% CI: 1.9-11.5%). Standardized morbidity ratio was 1584 (95% CI: 266-5232, p<0.001). Study limitations: The small sample size reduces the accuracy of risk estimates. Conclusions: This study analyzed prospectively for the first time data from South America demonstrating that patients with LCMN have a higher risk of developing melanoma than the general population (p<0.001).

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Abstract: Although giant congenital melanocytic nevus is a rare lesion, it causes significant deformity and carries a risk of malignant degeneration. Different surgical techniques for the lesion removal are described, including serial resection, resection with skin grafting, and resection and coverage with expanded skin flap (skin expanders). The aim of this study is to report the author's 40 years of experience with cases requiring at least 4 serial excisions to complete the treatment. Serial resection is an effective, safe, and simple technique that requires a lot of patience. Treatment often results in a single linear scar, requires no donor sites, nor large flaps. It is not subject to potencial complications of expanders and avoid aesthetic deformities depending on the location.

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