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Central Nervous System MRI Abnormalities and Neurologic Outcomes in Pediatric Patients With Congenital Nevi
TAKE-HOME MESSAGE
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The retrospective study compared data from 46 children with congenital melanocytic nevi (CMN) who underwent MRI of the central nervous system (CNS) due to concerns over their CMN with that of 306 children with CMN who had MRIs performed for other reasons. Of the 46 children, 8 had melanin in their CNS and 1 developed fatal CNS melanoma. All of these children had more than four CMN of at least medium size. Overall, 4 patients had other non–melanin-related findings. None of the 306 children with CMN that did not prompt an MRI evaluation had CNS melanin.
- CNS melanin was more likely to be present in children with multiple CMN of at least medium size.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
High-risk congenital melanocytic nevi (CMN) are associated with abnormalities of the central nervous system, prompting MRI screening guidelines.
OBJECTIVE
Describe MRI brain and spine abnormalities in children with CMN and report trends between nevus features, MRI findings, and neurologic outcomes.
METHODS
Retrospective review of individuals aged ≤ 18 years with an MRI of brain and/or spine and at least 1 dermatologist-diagnosed CMN.
RESULTS
352 patients were identified. 46 children had CMN that prompted an MRI of the brain and/or spine (50% male, average age at first image, 354.8 days). In these children, 8 (17%) had melanin detected in the central nervous system, of whom all had > 4 CMN. One developed brain melanoma (fatal). In patients without CNS melanin, 4 had concerning imaging. Concerning MRI patients had more neurodevelopmental problems, seizures, neurosurgery, and death compared to individuals with unremarkable imaging. 306 patients received MRIs for other reasons; none detected melanin. No children with only multiple small CMN (n=15) had concerning imaging.
LIMITATIONS
Lack of control group, cohort size, and retrospective methods.
CONCLUSION
MRI of the brain and spine is useful for detecting intervenable abnormalities in high-risk children. Healthy infants with few small CMN may not require screening MRI.
Additional Info
Central nervous system magnetic resonance imaging abnormalities and neurologic outcomes in pediatric patients with congenital nevi: A 10-year multi-institutional retrospective study
J Am Acad Dermatol 2022 Jun 15;[EPub Ahead of Print], H Neale, I Plumptre, L Belazarian, K Wiss, EB HawrylukFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The general consensus from prior retrospective cohort studies has shown that multiple congenital melanocytic nevi (CMN) present at birth may predict central nervous system (CNS) abnormalities, and screening with magnetic resonance imaging (MRI) has been suggested for patients with large or multiple CMN. This retrospective cohort study from Hawryluk concluded that concerning findings on MRI were most frequently found in patients with multiple and at least one medium size (1.5–20 cm) CMN. The most common abnormal finding was CNS melanosis with potential for neurodevelopmental problems or seizures. Increased quantity of CMN (>4) was associated with the highest risk; interestingly, a single CMN (regardless of size) was not a predictor of concerning MRI findings. For patients with multiple CMNs (>4) and one projected medium size CMN as an adult, it is prudent to conduct a screening brain or spine MRI to assess for CNS abnormalities.