title: An Exploratory Clinical Trial of a Novel Treatment for Giant Congenital Melanocytic Nevi Combining Inactivated Autologous Nevus Tissue by High Hydrostatic Pressure and a Cultured Epidermal Autograft: Study Protocol.
abstract: BACKGROUND
  Giant congenital melanocytic nevi (GCMNs) are large brown to black skin lesions that appear at birth and are associated with a risk of malignant transformation. It is often difficult to reconstruct large full-thickness skin defects after the removal of GCMNs.
  
  
  OBJECTIVE
  To overcome this difficulty we developed a novel treatment to inactivate nevus tissue and reconstruct the skin defect using the nevus tissue itself. For this research, we designed an exploratory clinical study to investigate the safety and efficacy of a novel treatment combining the engraftment of autologous nevus tissue inactivated by high hydrostatic pressurization with a cultured epidermal autograft (CEA).
  
  
  METHODS
  Patients with congenital melanocytic nevi that were not expected to be closed by primary closure will be recruited for the present study. The target number of nevi is 10. The full-thickness nevus of the target is removed and pressurized at 200 MPa for 10 minutes. The pressurized and inactivated nevus is sutured to the original site. A small section of the patient's normal skin is taken from around the nevus region and a CEA is prepared after a 3-week culturing process. The CEA is then grafted onto the engrafted inactivated nevus at four weeks after its retransplantation. The primary endpoint is the engraftment of the CEA at 8 weeks after its transplantation and is defined as being engrafted when the engraftment area of the inactivated nevus is 60% or more of the pretransplantation nevus area and when 80% or more of the transplanted inactivated nevus is epithelialized.
  
  
  RESULTS
  The study protocol was approved by the Institutional Review Board of Kansai Medical University (No. 1520-2, January 5, 2016: version 1.3). The study opened for recruitment in February 2016.
  
  
  CONCLUSIONS
  This protocol is designed to show feasibility in delivering a novel treatment combining the engraftment of inactivated autologous nevus tissue and CEA. This is the first-in-man clinical trial of this treatment, and it should be a promising treatment of patients suffering from GCMN.
  
  
  BACKGROUND
  University Hospital Medical Information Network: UMIN000020732; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000022198 (Archived by WebCite at http://www.webcitation.org/6jLZH2vDN).
authors: Department of Plastic and Reconstructive Surgery, Kansai Medical University, Hirakata, Japan. morimotn@hirakata.kmu.ac.jp.
authors: Naoki
authors: http://orcid.org/0000-0002-0712-3172
authors: N
authors: Morimoto
authors: Chizuru
authors: http://orcid.org/0000-0003-4549-2136
authors: C
authors: Jinno
authors: Michiharu
authors: http://orcid.org/0000-0002-0024-6807
authors: M
authors: Sakamoto
authors: Natsuko
authors: http://orcid.org/0000-0001-9785-1490
authors: N
authors: Kakudo
authors: Tetsuji
authors: http://orcid.org/0000-0003-0225-2407
authors: T
authors: Yamaoka
authors: Kenji
authors: http://orcid.org/0000-0002-3959-4227
authors: K
authors: Kusumoto
keywords: cultured epidermal autograft; giant congenital melanocytic nevi; high hydrostatic pressurization; inactivation