What are the techniques for giant nevi removal?

There are several different plastic surgery techniques used to remove moles of different sizes. Giant nevi are typically approached in one of three ways:

• Serial excision
• Excision and grafting
• Tissue expansion

Serial excision involves the removal of one portion of the lesion with primary closure of the wound followed by a similar additional surgery or surgeries to remove the remaining lesion. Between each surgical stage the patient will be allowed to heal and the scars and tissues start to soften and/or stretch to allow for re-excision without too much tension on the repaired incision.

Excision and grafting involve the removal of most or all of the lesion and closure of the skin defect with a skin graft from the patient or with skin substitutes. This technique allows for rapid removal of the abnormal tissue with fewer surgeries at the expense of a cosmetic wound closure. Skin grafts can leave more significant scarring and may prolong post-operative recovery time.

Tissue expansion is a technique invented to grow additional skin that can then be used as a skin flap or full thickness skin graft. During tissue expansion one or more silicone balloons are placed under the skin and then subsequently inflated with water over several weeks until the desired growth of skin is reached. By expanding available normal skin adjacent to the nevus, part or all of the nevus can ultimately be removed and then the extra skin used to replace the missing tissue and close the defect. Depending on the size of the lesion this process may need to be repeated to achieve near or complete removal of the lesion.

Sometimes these techniques are used together to treat this problem. For instance, a large lesion may first be serially excised to make it smaller until the skin is too tight to allow further excision at which point removal and grafting or tissue expansion and flap closure may be considered to complete the process.

Your surgeon will discuss the potential surgery options with you to help determine which techniques will provide the best potential surgical process and outcomes.