Angel in Amerika
Presented on March 3, 2002 by David Elpern, M.D.
Williamstown, Massachusetts

Often, we see patients who do not present a diagnostic challenge, but from the therapeutic standpoint demand much attention, thought and the wisdom of others. Here is a young patient about whom I could use your help.

The angel is a 3 and 1/2 year old child who moved to Massachusetts from Sweden a year ago. At birth, she had a 4.5 cm in diameter congenital nevus on the right mid back. Her mother was told not to worry. She thought she was told that it would not grow.

As the child has grown, the nevus has also increased in size. It is now 7 cm in diameter; which probably is just proportional growth.

Please click here to evaluate

My questions are:

1) Is excision advisable from a therapeutic standpoint?

2) Would the child be better off without this lesion even from the cosmetic standpoint?

3) Can scarring be minimized with a staged procedure? Excision as a simple elipse in one or two stages would be easy. I would send her to a pediatric plastic surgeon. But is it the right thing?

The literature on the subject can be confusing. The "experts" are often contradictory. The patient's mother is a calm Swede - very logical. She just wants to do the right thing. As do I. So please help.