title: Divided eyelid nevus: a lid-sparing, staged surgical approach.
abstract: OBJECTIVE
  To describe a method for staged partial resection of congenital divided eyelid nevus. The rationale, technique, and outcomes for this approach are described.
  
  
  METHODS
  Retrospective chart review of a case series.
  
  
  METHODS
  Clinical records of 12 patients with divided eyelid nevus were reviewed with attention to presenting features, surgical management, histopathology, and follow-up course. Surgical approach involved the use of bipolar and thermal cautery to ablate the eyelid margin component, skin excision for cutaneous lesions, and then repair with advancement flaps or skin grafting.
  
  
  RESULTS
  Eight patients with divided nevus were treated with a staged surgical approach: 5 primarily and 3 as revision cases. Average age was 16.3 years at primary presentation (range, 2-36 years), 16.5 years at initial surgery (range 2-36 years), and 36.0 years at presentation for revision (range, 12-72 years). Primary patients required 1 (n = 3) or 2 (n = 2) surgeries. Revision patients required 2 (n = 1) or 3 (n = 2) procedures in addition to those they had already undergone. Anterior lamellar repair was by granulation (n = 2), local skin flaps (n = 3), or skin grafts (n = 3). Average follow-up was 21.6 months (range, 0-98 months). No adverse effects or malignant transformations were seen.
  
  
  CONCLUSIONS
  Patients with divided eyelid nevi often present for surgical management because of cosmetic and functional concerns. Because small-to-medium congenital nevi have a low risk of malignant transformation, total excision may not be necessary. A staged surgical approach with cautery ablation and contouring of the eyelid margin component and surgical resection of the anterior lamellar portion may be a reasonable treatment strategy for these patients.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Washington University, St. Louis, Missouri. Electronic address: jacobss@vision.wustl.edu.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Jacobs
authors.forename: Steven M
authors.initials: SM
authors.lastname: Couch
authors.forename: Philip L
authors.initials: PL
authors.lastname: Custer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002425:Cautery / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005142:Eyelid Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009508:Nevus, Pigmented / Q000473:pathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D016038:Skin Transplantation; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult