Management of Congenital Melanocytic Naevi in Children: A French National Survey Using Clinical Vignettes
Hélène Aubert, Morgane Pere, Frédérique Bellier Waast, Pierre Perrot, Sébastien Barbarot, on behalf of the Groupe de Recherche en Dermatologie Pédiatrique
Management of congenital melanocytic naevi in childhood may vary depending on the habits and experience of the treating clinician. The aim of this study was to assess current practice and determinants of surgical excision decision-making among French physicians. A national survey was conducted among dermatologists, paediatricians and surgeons, using clinical vignettes illustrating 29 scenarios. The primary outcome was the decision to perform surgical excision in each vignette. Of the 11,310 decisions made by the 390 participants (257 dermatologists, 35 surgeons, and 98 paediatricians) surgical excision was chosen in 33% of cases. The stated motivations for performing surgical excision were: melanoma risk, aesthetic/psychosocial risk, or both, in 39%, 34% and 27% of cases, respectively. Physicians with a higher level of experience in oncodermatology were more likely to opt for surgical excision. The age of the child, the size of the congenital melanocytic naevi, and the visibility of the lesion had no influence on the decision to perform surgical excision.
Despite the frequency of congenital melanocytic naevi, their therapeutic management does not usually involve shared decision-making, and may vary depending on the habits and experience of each clinician. This survey reveals the variability of management of congenital melanocytic naevi among clinicians at a national level in France. Management varied depending on: the clinician’s level of experience in oncodermatology; their previous management of a melanoma on congenital melanocytic naevi; their seniority; and the case-load mix. National recommendations to standardize clinical practice and the information provided to patients should be developed to help guide a shared decision-making process.