Small and medium-sized congenital nevi in children: a comparison of the costs of excision and long-term follow-up.
BACKGROUND
Clinical decisions on whether to follow up or remove small and medium congenital melanocytic nevi (SMCMN) in children have cost implications that have not been studied.


OBJECTIVE
To compare the costs of excision of SMCMN in children with lifelong follow-up in a tertiary center.


METHODS
We elaborated models for the evaluation of the costs of excision and long-term follow-up. We retrospectively collected data on 113 consecutive excised SMCMN (105 single-step interventions and 8 multiple-step interventions) from the medical records of our pediatric dermatology unit from 2001 to 2007 and calculated and compared the costs (direct and indirect) of surgery and follow-up.


RESULTS
The mean +/- standard deviation and total cohort costs for single-step interventions were euro 1,504.73 +/- 198.33 and 157,996.20, respectively. Median and cohort lifelong follow-up costs were similar if performed every 4 years (1,482.66 +/- 34.98 and 156,679.63). For multiple-step interventions (3 or 4 steps), surgery costs were similar to those of annual lifelong follow-up. In the case of two-step surgery, costs were similar to lifelong follow-up every 2 years.


CONCLUSIONS
An analysis of the costs of surgery and long-term follow-up in children with SMCMN is possible. Although the clinical judgment of the dermatologist and parental opinion are the main determinants in the management of SMCMN, costs should also be taken into account.
Roldán
Fernando Alfageme
FA
Dermatology Service, Hospital Gregorio Marañon, Madrid, Spain. feralfarol@yahoo.es
Hernando
Almudena Bermejo
AB
Cuadrado
Alfonso
A
Blanco
Cristina Ciudad
CC
Fernández
Ricardo Suárez
RS
Hermosa
José Manuel Hernanz
JM
Ochaita
Pablo Lázaro
PL
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D008297:Male; D008954:Models, Biological; D009508:Nevus, Pigmented / Q000151:congenital / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000151:congenital / Q000473:pathology / Q000601:surgery*; D013514:Surgical Procedures, Operative / Q000191:economics*; D013997:Time Factors