High-risk congenital melanocytic nevi (CMN) are associated with abnormalities of the central nervous system, prompting MRI screening guidelines.
Describe MRI brain and spine abnormalities in children with CMN and report trends between nevus features, MRI findings, and neurologic outcomes.
Retrospective review of individuals aged ≤ 18 years with an MRI of brain and/or spine and at least 1 dermatologist-diagnosed CMN.
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.
Lack of control group, cohort size, and retrospective methods.
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.