Multiple-Staged Versus Single-Stage Surgical Excision for the Reconstruction of Congenital Melanocytic Nevi: A Meta-Analysis of Efficacy and Safety.

In 30 seconds

This meta-analysis compared multiple-staged with single-stage excision and reconstruction for congenital melanocytic nevi (CMN). It pooled seven retrospective cohort or clinical controlled studies involving 578 patients. Multiple-staged excision was associated with lower odds of major wound complications (OR = 0.54, 95% CI 0.30-0.97) and recurrence (OR = 0.45, 95% CI 0.22-0.93), as well as shorter and narrower scars. Cosmetic and patient satisfaction did not differ significantly between strategies. The findings suggest potential safety and scar-outcome advantages, but derive from non-randomised comparative evidence.

Key findings

• Multiple-staged excision was associated with fewer major wound complications than single-stage excision (OR = 0.54, 95% CI 0.30-0.97, p = 0.04).
• Recurrence was lower with multiple-staged excision (OR = 0.45, 95% CI 0.22-0.93, p = 0.03).
• Multiple-staged excision was associated with shorter scars (MD = -0.32 mm, 95% CI -0.52 to -0.12, p = 0.002) and narrower scars (MD = -0.04 mm, 95% CI -0.09 to -0.01, p = 0.04).
• Cosmetic satisfaction and patient satisfaction did not differ significantly between strategies (OR = 1.07, p = 0.80; OR = 1.29, p = 0.59, respectively).

Why it matters

CMN excision requires balancing wound safety, lesion control, scar outcomes, and patient experience. This synthesis suggests that staged excision may be associated with fewer major wound complications and better scar dimensions without a demonstrated satisfaction difference. These comparative outcomes can inform discussion of surgical approaches, while the evidence base does not establish that staging itself causes the observed advantages.

What to keep in mind

The synthesis included only seven studies, all retrospective cohort or clinical controlled studies; the abstract notes that direct comparative evidence is scarce.