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An Innovative Infant-Specific Protocol for Giant Nevus Excision: Staged Surgery with Progressive Tension-Relief Sutures
Faliang Wang, Ming Yang
Children's Hospital Zhejiang University School of Medicine, Hangzhou, China
Introduction
Giant congenital melanocytic nevi (GCMN) in infants carry a risk of malignant transformation and psychosocial distress, warranting early surgical intervention. However, achieving safe and complete excision in this age group is technically challenging due to limited skin laxity, immature anatomical structures, and concerns regarding functional and aesthetic preservation. We developed an infant-specific multistage protocol utilizing a progressive tension-relief suturing technique to enable complete nevus removal without the use of tissue expanders or skin grafts.
Case Presentation
Three female infants, aged 1 to 2 months, presented with GCMNs ranging from 10 × 8 cm to 18 × 14 cm, located on the lower back and buttock. Each patient underwent 2 to 4 staged excisions spaced 2–3 months apart. At each stage, customized excision lines were designed along relaxed skin tension vectors. Our innovative technique involved a dynamic suturing method in which deep dermal sutures were placed and gradually tightened over 3–5 days postoperatively, allowing for progressive skin adaptation and tension relief. This approach facilitated tension-free primary closure while avoiding ischemia and flap stress. All patients completed treatment without complications such as dehiscence, necrosis, or infection. At 3–6 months of follow-up, all patients demonstrated complete lesion clearance, well-healed scars with preserved back contour and spinal flexibility, and no functional impairment. Histopathology confirmed total excision without malignancy.
Conclusion
This novel infant-adapted surgical strategy provides a safe, expansion-free, and function-preserving method for early GCMN management. By combining staged resection with progressive tension-relief suturing, this technique enables effective nevus removal while optimizing scar quality, anatomic development, and long-term outcomes in pediatric patients.