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Three Part Question

In [a patient with no obvious neurology but a large congenital nevocellular naevus] is [screening with neuroimaging] in [identifying subclinical lesions]important?

Clinical Scenario

A 3 day old neonate female was seen by the neonatologist and noted to have a large congenital melanocytic/nevocellular naevus. The neonate had no focal neurology and was otherwise well in herself following a normal vaginal delivery. There was no family history of note.

Search Strategy

Medline interface on the world wide web. 1966 – February 2011
[({congenital nevocellular or melanocytic naevus.mp} AND {imaging} AND {screening}]
LIMIT to English

Search Outcome

3 papers were found which addressed the question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
V A Kinsler, S E Aylett, S C Coley,W K Chong, D J Atherton 13 July 2000 UK	43 children (20 boys and 23 girls) with a median age of 2.6 years, with congenital melanocytic naevi over 2 cm on th head or over spine were offered MRI of the brain and/or spine.	Prospective case control study	Lesion found on MRI prior to abnormal neurology		Abnormal neurology could have been present prior to the screening but not reported
Frieden IJ, Williams ML, Barkovich AJ. 1994	20 neurologically asymptomatic children with large or multiple congenital melanocytic naevi.	Prospective case control study	Abnormal MRI in 45%	33% of abnormal MRIs were due to intracranial melanosis
Ruiz-Maldonado R, del Rosario Barona-Mazuera M, Hidalgo-Galvan LR, et al. 1997	13 children with congenital melanocytic naevi and normal neurology who had a screening MRI.	Prospective case control	None of the patients had intrcranial melanosis on MRI	However 6 patients of 13 had anatomical abnormalities of the CNS	All were thought to be neurologically asymptomatic, but 11 were subsequently found to have neurological signs on examination.

Comment(s)

There is no evidence to determine if early detection of intracranial melanosis improves prognosis.

Clinical Bottom Line

Recommendation: All patients with large lesions should have MRIs of their CNS at an early stage and routine follow up with neurological history and examination.

References

1. V A Kinsler, S E Aylett, S C Coley,W K Chong, D J Atherton Central nervous system imaging and congenital Arch Dis Child
2. Frieden IJ, Williams ML, Barkovich AJ. Giant congenital melanocytic nevi: brain magnetic resonance findings in neurologically asyptomatic children. J Am Acad Dermatol 1994;31:423–9.
3. Ruiz-Maldonado R Giant congenital melanocytic nevi, neurocutaneous melanosis and neurological alterations. Dermatology 1997;195:125–8.