Congenital Melanocytic Nevus of the Nose: Clinical Experience and Reconstructive Approaches.

Background: Congenital melanocytic nevi (CMNs) of the nose are uncommon. These nevi present an aesthetic reconstructive challenge. This study presented our experience in surgical management of the varying presentations of these lesions. Methods: Seventeen patients with medium and large nasal CMNs were operated on between the years 2010 and 2020. Children with small congenital nevi amenable to excision and primary closure were excluded from this study. Data were collected regarding patient characteristics, surgical management, and postoperative outcomes and complications. Medium-sized nasal nevi isolated to the upper two-thirds of the nose were reconstructed with serial excision, whereas lower third nevi were reconstructed with full-thickness skin grafts or composite grafts. Larger nevi, with an extension into an additional facial unit, were reconstructed with expanded flaps from the forehead or cheek regions. Results: Children with nevi isolated to the nose had between 1 and 3 procedures including serial excision, skin grafts, or composite grafts. Children with extensive facial CMNs had between 2 and 8 procedures (for treatment of the whole facial nevus). Two patients were reconstructed with expanded cheek flaps, 1 with an expanded forehead flap, and 2 with both. Reconstructions were achieved with minimal complication rates and good surgical outcomes. Conclusions: Congenital nevi of the nose present a reconstructive challenge. The authors developed a treatment algorithm with the aim of offering an optimal surgical management plan. Longer follow-up is still needed given many of the patients will reach mature facial growth in the near future.