Treatment of Cutaneous Nevi

Nevi, commonly referred to as moles, are benign skin lesions frequently present from birth or appearing later in life. The vast majority of nevi (or naevi) pose no problem, but some may evolve over time and require monitoring or surgical removal. A large mole in a child will grow along with them and become increasingly noticeable with age. As a result, some moles enlarge and change in appearance. The child may then wish to have it removed during adolescence, which is unfortunately the least favorable time for surgery.

The best time for surgery, in order to achieve a barely visible scar, is before the age of 4. When the procedure is performed during the first 6 months of life, the scar may even disappear completely, as the dermis is still actively developing and leaves no visible trace of incision. The earlier the lesion is treated, the better it is to avoid potential complications.

Surgery may also be considered a preventive solution, in order to avoid any concerning transformation into a skin tumor and to preserve healthy skin.

When considering the removal of a mole, several criteria must be taken into account. Some moles can affect the patient’s appearance, especially when they are located on visible areas of the face or body. Their size, irregular shape, or position may make them aesthetically bothersome.

In such cases, surgical intervention may be proposed to improve the appearance of the skin, regardless of the patient’s age (with the exception of adolescence). A nevus located in an area subject to frequent friction, such as the neck or clothing lines, may also justify surgery.

The goal of the procedure is to improve the texture and overall appearance of the skin, allowing the patient to feel more comfortable with their image, without functional discomfort.

In general, moles require annual monitoring by a dermatologist, who will look for dysplastic features or signs of concerning evolution, with a potential risk of transformation into melanoma. If there is any doubt about a lesion, surgical excision with histological analysis allows confirmation of its benign nature. Most often, the dermatologist can remove the lesion. However, if it is located on the face, eyelids, tip of the nose, or on the ears, hands, feet, or ankles, it is preferable to consult a specialized surgeon, as the risk of poor scarring is higher.

Regardless of the child’s age, the indication is decided jointly by the dermatologist and the surgeon. It is preferable to avoid surgery during adolescence.

Pediatric surgical treatment consists of complete removal of the nevus, while preserving a margin of healthy tissue to ensure that all suspicious cells are excised. The complexity of the procedure depends on the size and location of the nevus. In all cases, the objective is to achieve a discreet scar that becomes increasingly difficult to see over time. When possible, a short and simple adapted suture is always preferred.

For very large lesions, the procedure may be performed in two surgical stages : the first removes approximately 75% of the nevus, and the second removes the remainder and improves the scar if necessary.

During the procedure, light general anesthesia is often sufficient to ensure the child’s comfort without increasing risk. The surgery is performed on an outpatient basis, allowing the child to return home the same day after a few hours of postoperative monitoring. The operation is brief, but each step is carried out with precision to minimize risks and optimize aesthetic results.

Normal activities can be resumed immediately. A first follow up visit takes place one week after surgery to check healing and ensure everything is progressing well. A second follow up is scheduled two months later to assess the evolution of the result and confirm that no abnormality has appeared in the operated area. This medical follow up ensures the stability and quality of the outcome.

The result is immediate and continues to improve over time. In some cases, when surgery is performed early enough in life, the scar may become completely invisible. In children, healing is often rapid, which significantly increases the chances of achieving an optimal aesthetic result.