Congenital melanocytic nevus of the face: a clinical image

A 49-year-old female presented with a congenital pigmented lesion involving the right hemiface since birth. The lesion gradually enlarged during childhood and adolescence and stabilized in adulthood. She denied ulceration, bleeding, or pain but reported significant psychosocial distress due to facial disfigurement. During adolescence, she was advised laser ablation; however, owing to financial constraints, she underwent only a single session that resulted in a faint hypopigmented patch along the superior margin of the lesion, with further treatment discontinued. Clinical examination revealed an extensive, well-demarcated, hyperpigmented plaque with irregular thickening and coarse terminal hypertricosis extending from the periorbital to the mandibular region. No satellite nevi were observed. Neurological and systemic examination were remarkable, and visual and oral functions were preserved. Based on characteristic morphology and distribution, a clinical diagnosis of Giant Congenital Melanocytic Nevus (GCMN) was made. Different diagnosis included Becker´s nevus, nevus sebaceous, and epidermal nevus. The patient declined biopsy and opted for conservative follow-up. GCMN- defined as a congenital melanocytic nevus exceeding 20cm in projected adult diameter- is rare, with an estimated incidence of 1in 20,0 live births. It carries a lifetime melanoma risk of 5-10% and may be associated with neurocutaneous melanosis. Management is cosmetically and functionally critically regions demands individualized, multidisciplinary surveillance and long-term follow-up.