Adjunctive treatment of congenital pigmented nevi with phenol chemical peel

The purpose of this study was a retrospective evaluation of the treatment o f congenital pigmented nevi using the phenol chemical peel technique. Patie nts were treated with standard Baker formula in the operating room under ge neral anesthesia or intravenous sedation with continuous electrocardiogram monitoring. A total of 20 patients were reviewed (13 girls and 7 boys, mean age 3.5 years). Eight patients had nevi located on the face, five patients had trunk lesions, and three patients had lesions on the thighs. Two patie nts had nevi located on both the face and the trunk, and two patients had i nvolvement of the face, trunk, and thigh. Three of the above patients had t he classic "bathing trunk" distribution of the nevi. A test area was peeled in four patients, and in five patients preoperative biopsies were performe d to rule out malignancy before initiation of therapy. An average of 2.6 tr eatments were performed per patient. Two patients had adjunctive dermabrasi on to increase the depth of peel and to contour surface ir regularities. Th e length of follow-up ranged from 6 to 84 months with a mean of 28 months. Healing of the wounds occurred within 2 to 3 weeks postoperatively. Seventy -five percent of patients had satisfactory cosmetic improvement in the appe arance of the lesions following treatment. Four patients had recurrence of the pigmentation after an initial lightening response, three of whom had th eir nevi subsequently excised. There was no incidence of hypertrophic scarr ing or cardiac and/or renal complications. There was one death from complic ations of leptomeningeal melanocytosis. Chemical peeling of congenital pigmented nevi is an acceptable alternative method of therapy for those lesions that are too large for excision and pri mary closure or for lesions in which excision would result in unacceptable scars in areas such as the face.