Congenital disease skin is a large pigment spot, which is officially called a giant nevus (melanocytic, verrucous). This disease contributes malignant degeneration, therefore, the medical response must be timely. Patients need to regularly visit a dermatologist in order to promptly diagnose the transformation of pigment tissues into cancer cells. Melanocytic nevus is a melanoma-dangerous neoplasm, but is initially defined as benign tumor.

What is a giant nevus

In this case we're talking about about large birthmarks that have a deep purple hue and are hairy. The neoplasm is formed in the prenatal period at an obstetric period of 10–25 weeks. This disease is extremely rare, and a patient who has it automatically falls into the oncology risk group. Classification according to ICD code is as follows congenital disease, like a melanoform nevus.

Causes

Etiology pathological process is a difficult to predict violation natural process melanoblast differentiation, which progresses from 10 to 25 obstetric weeks. Doctors have determined that there is a genetic factor, intrauterine mutations of the fetus. The main causes of the disease have not been fully identified, but simultaneously develop in children's body following diagnoses: hydrocephalus, epilepsy, Recklinghausen's neurofibromatosis, primary melanoma of the soft shell of the brain.

Symptoms

When a child is born, pigment spots are not always visible on his body. Sometimes they appear only on the 7th–10th day of a newborn’s life and grow rapidly. The focus of the pathology can be localized on the torso, limbs, neck or scalp. Additionally, small nevi may appear located near the giant neoplasm. Other signs that characterize verrucous nevus are presented below:

• changed skin tone - from light purple to deep black;
• aesthetic defect associated with hair pigment spots;
• small skin rashes, hyperemia of the dermis;
• visible swelling of the epidermis, heterogeneous structure;
• absence painful sensations upon palpation.

Diagnostics

A giant congenital nevus is preceded by intrauterine pathologies that are difficult to differentiate. However, diagnosis of large visible pigment spots is possible during the first examination of a clinical patient by a specialist. Besides, in laboratory conditions doctors carry out histological examination, necessary to exclude the spread malignant neoplasm. To study in detail the structure and edges of a giant-shaped nevus, it is necessary to undergo dermatoscopy and skiascopic examination to magnify the lesion 10-30 times.

Treatment of giant nevus

For a giant hair growth, doctors resort to surgical removal nevus after detailed diagnostics clinically and laboratory. Otherwise, there is a high probability of a giant tumor becoming malignant already in the first year of a small patient’s life. Treat nevus conservative methods ineffective and even dangerous to health, and proven remedies alternative medicine provide only minor visible changes on the skin.

Surgical method

Large birthmarks are subject to surgical excision, since if they are not removed in a timely manner, malignant diseases skin. The procedure consists of complete excision of the nevus, including 0.5 cm of adjacent healthy skin. If the focus of the pathology is located in an inconvenient place on the body, the surgeon excises it in stages after a detailed histological examination and a series of laboratory research.

After surgery and removal of the nevus, noticeable scars and cicatrices may remain on the body. Eliminate aesthetic defects it is possible through skin grafting using the method of free dermal transplantation or autodermoplasty with transplantation of one’s own tissues at vascular connections. The risk of potential complications is minimal, but you will still need to visit a dermatologist every 6 months for the rest of your life. After the operation, the rehabilitation process is short; at first, the patient is advised to refrain from skin contact with sun rays.

Folk remedies

Alternative medicine methods can reduce the severity of nevus symptoms and make the giant tumor less noticeable on the body. When making the final selection of recipes traditional treatment it is necessary to individually consult with a dermatologist and dermato-oncologist to eliminate the risk of contraindications, side effects arising from the plant components of the composition. Here are some effective ones folk remedies For home use:

1. Celandine juice. It is recommended to lubricate the nevus with fresh celandine concentrate and properly treat the boundaries of the neoplasm. The procedure should be carried out up to 5 - 6 times a day for 2 - 3 weeks.
2. Vinegar essence. Lubricate the foci of pathology with the prepared composition up to 3 – 4 times a day. The procedures are painful, but very effective. Carry them out for 2 - 3 weeks in the absence of local and allergic reactions.
3. Hemp oil. This natural remedy evaporates affected tissue, removes nevi. Lubricate the giant growth with oil 3-4 times a day for 2-4 weeks. The procedure is completely painless, but its effectiveness is 3 – 5%.

“I want to remove moles,” the patient tells me and shows me a huge nevus... Meanwhile, she hides it so cleverly with her hair that it’s impossible to see it without special preparation.

The nevus has been present since birth and increased in proportion to the patient's height.

Recently, the nevus has become frequently injured and the patient wants to do something to remove it. Appeal to local doctors did not give anything specific, they shrugged their shoulders and limited themselves to general recommendations..

On examination: giant congenital melanocytic nevus dimensions 45x34 cm, with deep folds, tumor-like shape, flesh-gray color. Black spots and hair growth on the surface are identified along its lower edge.

In addition, there are single nevi up to 1.5 cm in size, brownish-black in color with hair growth.

Dermoscopic examination reveals dark-colored diffuse-focal pigmentation, indicating a deep-lying pigment.

At the same time, when studying individual small nevi, their melanocytic origin is clearly determined by the presence of a pigment network and pigment around the hair follicles.

Clinical diagnosis

Giant congenital nevus

Nuances

Giant congenital nevus (syn. congenital pigmented nevus, congenital noncellular nevus, etc.) generally has a benign course, but is in the group of melanoma precursors.

The frequency of transformation of such nevi into melanoma is directly dependent on their size. In this regard, they are classified depending on their maximum diameter: small - less than 1.5 cm, medium - from 1.5 to 20 cm and giant - more than 20 cm in diameter. Giant nevi can transform into melanoma in 6-10% of cases.

Congenital nevi are characterized increased content melanocytes in the basal layer of the epidermis, as well as the detection of nevus cells in the lower third of the reticular layer of the dermis and subcutaneous tissue. In addition, nevocytes are found in skin appendages - ducts sweat glands, hair follicles, sebaceous glands. This can also be detected by dermoscopic examination (see dermatoscopy images).

It should be remembered that nevus cells in a giant congenital nevus can grow into the dura mater and give manifestations of neurogenic symptoms, hydrocephalus, epilepsy, etc.

Congenital nevi in ​​adults usually remain stable.

Removal of congenital giant nevi is carried out in specialized clinics specialists - plastic surgeons. Often operations are carried out in stages, followed by skin grafting. There are several similar clinics in Moscow, where such patients should be referred.

Definition. Congenital benign melanocytic nevi, which in newborns and young children account for 5% or more of the body surface area, and with adolescence have sizes from 20 cm or occupy an entire anatomical region or most of it.
It is currently believed that giant congenital nevi are gamartoms, which have a neuroectodermal origin and a complex structure.

Elements of the rash of a giant congenital nevus. A plaque raised above the skin level. Satellite nevi are often located around the main lesion. The skin pattern is disturbed. Nodules and papules are often found on the surface of the nevus and, as a rule, are rough, dark hair. The shape is round, oval or fancy. The boundaries are smooth and regular or uneven.

Color. Usually darkly pigmented formation.

Palpation. It usually has a soft consistency.

Localization of giant congenital nevus. Symmetrical or one-sided on any area of ​​the skin, occupying large areas.

Clinical differential diagnosis . There are no diagnostic difficulties due to the typical clinical picture. With a slight elevation of the plaques above the skin level, they are differentiated from Becker's nevus, which occurs in childhood or later. In addition, there is often more hair on its surface than in congenital melanocytic nevus.

Course and prognosis of giant congenital nevus. Some publications state that melanomas (cutaneous or intraorgan) develop in approximately 5% of patients with giant nevi. Additionally, about half of cases occur in the first few years of life or within the first 10 years of life. According to other data, throughout life, malignant transformation into skin melanoma occurs in 1/3 of patients with giant congenital nevi.

During the first 20 years of life with a risk of 6.3%. When nevi are localized in the head and spine, it is necessary to perform magnetic resonance imaging to exclude neurological lesions. By doing this study in 43 patients with the indicated localizations, in 7 cases lesions of the central nervous system were detected: lesions of the meninges, cerebellar astrocytoma, cyst. Of these, 6 patients experienced pathological neurological symptoms during the first 18 months of life.

When giants are located in the area lower limbs it is possible that atrophy of the subcutaneous fatty tissue may develop underneath without changes in the bone and muscle tissue. There are publications about the combination of a giant nevus in newborns with damage to the placenta in a woman in labor.

Treatment of giant congenital nevus. It is advisable to remove giant congenital nevi as early as possible, since the risk of developing melanoma is high even in the first 3-5 years of the patient’s life. Treatment is carried out by an oncological surgeon using excision and plastic correction. However, often it is not possible to perform the operation due to the size and/or location of the pigment formation.

There is an opinion about the possibility of using dermabrasion to remove giant nevi. However, it is more often believed that this manipulation and other interventions can further provoke the development of skin melanoma.

It's innate benign neoplasm skin, which is a large pigment spot (more than 20 cm), sometimes occupying a significant part of the limb or torso. Thanks to the characteristic appearance Diagnosing such a nevus is not difficult. A giant pigmented nevus is a melanoma-dangerous nevus, so it is advisable to remove it. However, due to the large size, this is not always possible. Patients with unremoved nevus should undergo regular examinations by a dermato-oncologist for timely diagnosis the beginning of its malignant transformation.

General information

The emergence of a giant pigmented nevus is caused by a disruption of the process of differentiation of melanoblasts that occurs in the fetus in the period from the 10th to the 25th week of its intrauterine development. The frequency of birth of a child with such a nevus is 1 in 500 thousand newborns. However, according to some data, giant nevus occurs in 1-2% of the world's population. The disease can be combined with other congenital anomalies, for example, with hydrocephalus, Recklinghausen's neurofibromatosis, epilepsy, primary melanoma of the pia mater.

Symptoms of a giant pigmented nevus

Due to its enormous size, a giant pigmented nevus often occupies entire anatomical areas. It can be located on the torso, limbs, neck or head. With its symmetrical arrangement, a pattern resembling a vest appears on the body, and a collar appears on the neck. It is possible to combine a giant nevus with multiple small nevi, which are usually located at some distance from it.

The surface of the giant nevus is uneven, the color can vary from gray and brown to black. Over time, the skin of the affected area thickens and pigmentation increases. Wherein different areas nevi can have different colors. The surface of the nevus becomes heterogeneous, bumpy and warty. In most cases, hair appears on certain areas of the nevus. Since the giant pigmented nevus grows slowly, as the child grows, a relative decrease in the size of the nevus is observed. At the end adolescence There is a decrease in the pigmentation of the nevus and a cessation of its thickening.

Like other congenital nevi, a giant pigmented nevus remains on the skin of its owner throughout his life. Such nevi persist even into very old age, when a gradual disappearance of all acquired nevi occurs.

Complications of giant pigmented nevus

The main complication of a giant nevus is its malignancy and transformation into melanoma. This process can be triggered by various acute or repeatedly traumatic effects on the nevus: mechanical, radiation (including sun rays), chemical.

The transition from a giant pigmented nevus to melanoma can occur at any age. According to various sources, this occurs in 2-13% of cases of the disease. When a nevus transforms into melanoma, it is noted accelerated growth, changes in shape and color, bleeding, the appearance of erosions and crusts on the surface.

Diagnosis of giant pigmented nevus

The diagnosis of giant pigmented nevus can be made by characteristic appearance and the fact of the presence of a nevus on the skin from birth. Additional Research necessary for timely detection of transformation of nevus into melanoma. Most often, dermatoscopy and siascopic examination are used for this purpose, allowing one to study the structure and edges of the nevus under 10-30x magnification. Using dermatoscopy to plan the operation, the boundaries of the nevus are accurately determined.

The histological picture of a giant pigmented nevus, like other congenital pigmented nevi, is characterized by the absence of melanocytes in the papillary layer of the dermis and an increase in their content in the basal layer of the epidermis. Nevus cells are detected in the lower layers of the dermis, subcutaneous fatty tissue and skin appendages: ducts of the sweat and sebaceous glands, hair follicles. With a giant pigmented nevus, nevus cells also penetrate into the muscles, bones and meninges.

Treatment of giant pigmented nevus

Despite big sizes nevus and infancy patients, The best way Its treatment is removal. Such therapeutic tactics associated with high probability malignancy of a giant nevus, which can occur already in the first year of life. The decision about surgery is made individually, taking into account the location and size of the nevus, the age and health status of the patient, the degree of possible disability as a result of the operation, etc. If the operation is postponed, the patient needs constant monitoring by an oncologist with examinations at least once a quarter.

Surgical treatment of giant pigmented nevus is carried out jointly by dermato-oncologists and plastic surgeons. It consists of complete excision of the nevus with a coverage of 0.5 cm healthy skin, located on the border with it. If the size and location of the nevus do not allow it to be removed immediately, stage-by-stage excision is performed. The material removed during the operation must undergo histological examination. Large skin defects resulting from the operation require closure by skin grafting. Plastic surgery can be performed using free skin grafting or autodermoplasty with transplantation of one’s own skin flaps at vascular anastomoses. For plastic closure of the defect, technology is also used artificial cultivation cultures of own epidermal cells on synthetic analogues of the dermis.

The word “oncology” scares every person, but this word may not always mean a tumor dangerous to health. It should be taken into account that almost all of us have moles, and they can also be considered, to some extent, oncology. Most often, pigmented skin nevi, or, as they are also called, moles or spots, can be found on our skin.

What is a nevus?

The term "pigmented nevus" usually means benign education on the skin, consisting mainly of melanocytes - cells containing the pigment "melanin". Benign this education called because when proper care behind the area of ​​skin where the nevus is localized, it will never degenerate into malignant tumor, which can spread throughout the body and cause significant harm to health.

Congenital nevi usually appear due to the fact that in the embryonic period a partial redistribution of melanocyte precursors occurs, and some of them settle in the skin. Some of them develop throughout life. Typically, pigmented nevi are located deep in the skin and do not rise above it; they have a smooth, soft surface and clear boundaries. Pigmented nevi can be located on any part of the skin, however, they mainly appear on the limbs and back.

Types of nevi

There are many various classifications nevi. First of all, they can be divided by size:

• small nevi, the size of which ranges from 0.5 to one and a half centimeters;
• medium nevi up to 10 centimeters in size;
• large nevi - more than 10 centimeters;
• giant pigmented nevus. Such nevi occupy a fairly large area of ​​the body (a limb or more), rarely - half of the face or neck.

Morphologically there are several forms age spots:

• blue nevus;
• Dubreuil's limited melanosis;
• pigmented border nevus;
• nevus of Ota;
• intradermal pigmented nevus, etc.

The peculiarity of each of these formations is their structure, location on the skin, morphological characteristics, as well as the ability to degenerate (malignancy and transformation into melanoma). All of them are conventionally considered precancerous diseases, and only some are melanoma-dangerous and capable of metastasis.

In addition, it is possible to distinguish such forms as pigment nevus, melanocytic nevus, mixed nevus (depending on what it is formed by - melanocytes or the released melanin pigment).

Classification of nevi according to ICD-10

According to international classification diseases (ICD), pigmented nevus can be divided according to its location. Specifically for them, separate classes have been identified (for example, D22) and types, such as 78.1 and KYu82.5.

The classification includes a division of nevi into melanoform (D22 with definition of the affected area - eyelid, ear, other parts of the face, scalp, trunk, upper and lower extremities, as well as nevus of unspecified etiology), non-tumor nevi (I78.1 with the exception of some forms , including class D22), congenital non-tumor nevus. Each of them has its own course and characteristic features. The treatment used for them is also radically different - some must be removed only surgically, others - under the influence physical methods, and still others cannot be treated at all.

This division was created to determine the risk of malignancy and patient management tactics.

Signs of malignancy

Sometimes it can happen that a nevus transforms into melanoma. It usually develops in case of damage to the nevus. Predisposing factors for this are the large size of the nevus, location on open areas body, as well as in natural folds (injured as a result of a cut, prolonged friction - if the nevus is located, for example, in the collar area, on the feet). At the same time, it begins to undergo qualitative changes - the color of the birthmark changes from brown to intense black, the spot itself begins to rise above the surface of the skin and bleed.

The boundaries of the spot become unclear, blurred, and the spot itself begins to quickly grow to the sides. As the process progresses, the surface of the nevus may begin to hurt, and itching and tingling appear in this area. If at least one of the above symptoms appears, you should immediately seek help from an oncologist.

Group of melanoma-dangerous nevi

As mentioned, not all nevi undergo degeneration. However, there is a certain group of pigment accumulations that become malignant in almost 100% of cases. These include borderline pigmented nevus (located on the border of the epidermis and dermis, prone to damage), blue nevus (has a characteristic color, slightly rises above the surface of the skin, appears mainly in Asians), nevus of Ota (looks like black and bluish spots , located mainly on the face), giant hair pigment nevus (congenital, manifests itself in children, has intensive growth relative to the baby's height). Diagnosis of these nevi is usually not difficult, but treatment is not always simple and requires careful preliminary diagnosis.

All these nevi, when detected, require immediate treatment, since in case of untimely diagnosis and treatment they develop into melanoma.

Diagnosis of pigmented neoplasms

If such neoplasms are detected on the surface of the body (especially if they appeared within a short period), you should immediately consult a doctor. He is obliged to appoint a certain list diagnostic measures to determine the form of the pathological process.

Diagnosis begins with general examination, during which the oncologist can already guess the type and level of danger birthmark, as well as determine a further plan of action.

If there is weeping or the spot periodically begins to bleed, you should take swabs from the surface of the spot. It is strictly forbidden to take a biopsy, as it is a factor predisposing to malignancy.

In addition to these methods, you can use a blood test for tumor markers (melanoma is characterized by such groups of tumor markers as TA90 and SU100), or examine the surface of the spot under a fluorescent microscope.

Treatment methods for nevi

What to do if suddenly a short time Has a pigmented nevus appeared on the surface of your skin? It can be treated as surgically, and with the help of some other manipulations.

If the nevus is small and no changes are observed on its part, you can limit yourself to ordinary observation with careful isolation of the spot from damaging factors and ultraviolet radiation.

Previously used drug treatment nevi - hormonal ointments were used, but they did not give the desired effect and only contributed to the progression of the process (as they most often had an irritating effect on the surface of the spot and served as a trigger for the start of its malignancy).

According to the recommendations of specialists in the treatment of patients with cancer, preference is currently given to surgical methods. Additional methods they are not used in the treatment of oncology, but only occur during prophylactic removal of nevi.

Surgery

If you do have a pigmented nevus, it is best to remove it, as already mentioned, surgically.

The operation is performed under local or general anesthesia. The pigment spot is excised within healthy tissue (to prevent relapse, since tumor cells may remain in nearby tissues; the distance from the pigment spot is usually about 5 centimeters). It is imperative to carry out careful hemostasis with control, since pigment spot cells can enter the bloodstream, which will create conditions for metastasis. After removing the skin area, the surgical wound is thoroughly cleaned (in order to remove any nevus cells that may have remained in the wound). After this, the wound is sutured with aseptic sutures and heals in about a week or two.

The likelihood of relapse (in the absence of metastasis) is minimal. High percentage of normal transfer postoperative period and recovery. A consultation with a pediatric oncologist is required if a pigmented nevus has developed in a child, since the operation can cause significant harm to the child’s health.

Additional methods for removing pigmented nevi

Besides surgical intervention, there are several additional techniques that will help eliminate pigmented nevus. Its removal is carried out using cryodestruction, electrocoagulation and the use of a laser.

Cryodestruction involves the use of local freezing (using liquid nitrogen) and subsequent removal of damaged tissue.

During electrocoagulation, the area of ​​the pigment spot is cauterized electric shock, causing intradermal coagulation of protein molecules. After this, the damaged area of ​​tissue is removed. Plus this method is anemia (due to sealing of blood vessels) and minimal risk entry into the bloodstream of melanocytes and tumor cells.

Laser is one of the latest innovations in pigment spot removal. The operation is painless and does not require anesthesia or hemostasis. Melanocytes are damaged using infrared laser radiation (peroxidation processes are launched, damaging organelles), after which they are resorbed.

Management of patients with inoperable pigmented lesions

Sometimes it happens that a pigmented nevus becomes malignant and begins to metastasize. If you miss the beginning of its degeneration and start the process, you can bring the patient to a state of inoperability. In addition, the impossibility of performing an operation may depend on the patient’s age and his state of health (the operation is contraindicated for elderly people, as well as people in a state of decompensation cardiovascular diseases). The operation is not performed on persons who refuse surgical intervention, as well as those for whom surgery could cause significant harm to their health (for example, people with immunodeficiency).

Such people are subject to conservative symptomatic treatment using analgesics, anti-inflammatory drugs, and hypercoagulants. To alleviate the condition, you can use some physical procedures. Treatment is supplemented by taking sedatives, as well as mild cytostatics (except for those who have immunodeficiency).

Prevention of the development and malignancy of pigmented neoplasms

In order to prevent the appearance of new age spots and prevent them from transforming into a malignant tumor, a set of certain measures should be used that will help keep them in a relatively stable state.

First of all, excessive sun exposure should be avoided. Ultraviolet rays provoke the activation of melanin and the development of melanocytes. With excessive insolation, the spots may degenerate, as well as the formation of new ones. For protection, you can use special protective creams, but they should be applied very carefully, trying not to damage the plaque.

Protecting stains from injury

It is recommended to cover nevi located in open areas with clothing. Those neoplasms that are localized in areas of increased trauma are recommended to be removed before they become traumatized.

You should also avoid visiting solariums, as they also contribute to the development of melanoma. This is especially dangerous for those under 28 years of age.

Should I delete education data?

Everyone has probably asked a similar question. For some, these nevi are completely safe and the risk of their germination is minimal. For others (especially those who have a genetic predisposition), the risk of the spot degenerating into melanoma is extremely high, and a late decision on treatment can be fatal.

Therefore, the question of removing each nevus is purely individual. If you are willing to take the risk of surgery, it is best to remove it and forget about its existence. If you are ready to risk your health and not touch the nevus, it’s up to you, but with medical point vision, it is better to take care of your health prematurely and get rid of this small but very formidable formation, so as not to regret your decision later.