Cerebriform congenital melanocytic nevus of scalp and its management using tissue expansion

Congenital melanocytic nevi are benign proliferations of cutaneous nevomelanocytes. Usually, they manifest at birth or become apparent within the first few years of life. The nevi show variable surface morphology (papular, rugose, verrucous, or cerebriform). Congenital melanocytic nevus showing cerebriform morphology is a rarity. Early diagnosis and surgical excision are usually recommended in congenital melanocytic nevus to prevent the future risk of malignant transformation which is higher in larger lesions, especially in giant forms (>20 cm in size). An excision of the lesion also helps to avoid the social and psychological consequences arising out of significant cosmetic deformity. We report a 21-year-old patient who presented with a cerebriform congenital melanocytic nevus measuring 10 cm × 7 cm × 2 cm in the right parietal region. Early-onset, pigmented lesion with a cerebriform surface, and the histopathology features of congenital melanocytic nevus were the points that favored the diagnosis of cerebriform congenital melanocytic nevus in our patient. He was treated with excision of the lesion and defect coverage with tissue expansion in two stages. Two rectangular tissue expanders were placed beneath the galea aponeurotica (one with a capacity of 300 cc in the left parietal region and another with 500 cc in the occipital region). Both the expanders were inflated twice to their capacity. Second stage surgery was performed after about 3 months in which the tissue expanders were removed and the pre-expanded scalp skin was used to drape the scalp defect that resulted from the excision of the lesion. An excision and a two staged reconstruction of the scalp using tissue expanders, may ensure a good aesthetic outcome in the management of intermediate to large sized congenital melanocytic nevus.