Congenital Nevocellular Naevi – Do we need to screen with neuroimaging?
Date First Published:
February 15, 2011
Last Updated:
February 28, 2011
Report by:
Nada Al-Hadithy, ST3 Plastic Surgery (St John's Hospital Livingston)
Search checked by:
Dr Jo Mennie, St John's Hospital Livingston
Three-Part Question:
In [a patient with no obvious neurology but a large congenital nevocellular naevus] is [screening with neuroimaging] in [identifying subclinical lesions]important?
Clinical Scenario:
A 3 day old neonate female was seen by the neonatologist and noted to have a large congenital melanocytic/nevocellular naevus. The neonate had no focal neurology and was otherwise well in herself following a normal vaginal delivery. There was no family history of note.
Search Strategy:
Medline interface on the world wide web. 1966 – February 2011
[({congenital nevocellular or melanocytic naevus.mp} AND {imaging} AND {screening}]
LIMIT to English
[({congenital nevocellular or melanocytic naevus.mp} AND {imaging} AND {screening}]
LIMIT to English
Outcome:
3 papers were found which addressed the question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Central nervous system imaging and congenital V A Kinsler, S E Aylett, S C Coley,W K Chong, D J Atherton 13-Jul-00 UK | 43 children (20 boys and 23 girls) with a median age of 2.6 years, with congenital melanocytic naevi over 2 cm on th head or over spine were offered MRI of the brain and/or spine. | Prospective case control study | Lesion found on MRI prior to abnormal neurology | Abnormal neurology could have been present prior to the screening but not reported | |
| Giant congenital melanocytic nevi: brain magnetic resonance findings in neurologically asyptomatic children. Frieden IJ, Williams ML, Barkovich AJ. 1994 | 20 neurologically asymptomatic children with large or multiple congenital melanocytic naevi. |
Prospective case control study | Abnormal MRI in 45% | 33% of abnormal MRIs were due to intracranial melanosis | |
| Giant congenital melanocytic nevi, neurocutaneous melanosis and neurological alterations. Ruiz-Maldonado R 1997 | 13 children with congenital melanocytic naevi and normal neurology who had a screening MRI. | Prospective case control |
None of the patients had intrcranial melanosis on MRI | However 6 patients of 13 had anatomical abnormalities of the CNS | All were thought to be neurologically asymptomatic, but 11 were subsequently found to have neurological signs on examination. |
Author Commentary:
There is no evidence to determine if early detection of intracranial melanosis improves prognosis.
Bottom Line:
Recommendation: All patients with large lesions should have MRIs of their CNS at an early stage and routine follow up with neurological history and examination.
References:
- V A Kinsler, S E Aylett, S C Coley,W K Chong, D J Atherton. Central nervous system imaging and congenital
- Frieden IJ, Williams ML, Barkovich AJ.. Giant congenital melanocytic nevi: brain magnetic resonance findings in neurologically asyptomatic children.
- Ruiz-Maldonado R. Giant congenital melanocytic nevi, neurocutaneous melanosis and neurological alterations.