Many people with large nevi have problems with itching or other discomfort. Lotions and creams can alleviate some of that discomfort. But it is important to note that there are currently no creams, lotions or other topical products one can rub on the skin that can remove a nevus. (There are quite a lot of things one could rub on the skin that would irritate or damage it, so any kind of “whitening agent” is highly discouraged, as they are always aggressive and sometimes toxic.) Monitoring a CMN without surgical intervention Removing a congenital melanocytic nevus is a personal decision to be taken ideally after consultation with more than one informed, trusted physician. Many patients who have a large CMN, or their families if they are too young to decide for themselves, prefer to leave it unoperated for various valid reasons. CMN removal Sometimes medical intervention can help cosmetically, sometimes not. It depends on where the nevus is, the size, skin type (nevus can be thin and fragile or thick and bumpy)and the patient. There are various medical possibilities including shaving the upper layers of skin (curettage or dermabrasion)to reduce the visible pigment or to de bulk a thick CMN, excision by either serial excision, expanded full thickness skin flaps (expanders), or split skin grafting, and laser for both pigment and hair reduction (not removal). Most children with a CMN will have a paediatrician, dermatologist and plastic surgeon as part of their regular care team, others may also have a neurologist, psychologist, GP, ophthalmologist, ear nose and throat specialist, dental specialist, scar management specialist, physiotherapist, oncologist, or social worker. Regular medical appointments are usual, particularly in the early years. Occasionally periods of absence are required while undergoing treatments. There is no way to medically reduce the risks associated with CMN. We just don’t know enough about it yet. What about all those other spots? Many but not all patients with CMN will have other spots as well as the primary nevus. These are generally referred to as satellite nevi. The skin structure is the same as in the primary nevus. These ‘spots’ can continue to develop after birth and in fact can continue to appear over the lifespan.

One of the most frequently asked questions is “What can be done about it?” We all want to think modern medicine has miracles to offer us, but there are no magic answers, yet.