Review suggests staged surgery may lower some risks for congenital moles
A review of seven nonrandomized studies found fewer major wound problems, recurrences, and slightly smaller scars after staged excision, but satisfaction was similar.
Moderate evidenceReviewInterpret with caution
Medical disclaimer: This article summarizes research findings and is for informational purposes only. It is not medical advice.
Editorial illustration — not from the study.
The analysis included 578 people whose congenital melanocytic nevi were surgically removed and reconstructed. The studies mainly involved large or giant lesions and medium-sized facial lesions in children. Multiple-staged surgery included procedures performed in two or more stages, including some approaches using tissue expansion or combined flaps.
Compared with single-stage surgery, staged surgery was associated with lower odds of major wound complications and recurrence. The pooled differences in scar size were statistically significant but small: about 0.32 millimeters shorter and 0.04 millimeters narrower on average. The analysis found no significant difference in cosmetic satisfaction or overall patient satisfaction.
What the review covered
This was a systematic review and meta-analysis of human comparative research. The researchers searched seven databases for studies available through October 31, 2025, and included seven retrospective cohort or clinical controlled studies involving 578 people with congenital melanocytic nevi who underwent removal and reconstruction. They compared surgery performed in multiple stages with complete removal and closure in a single procedure. Outcomes included major wound complications, recurrence, cosmetic satisfaction, patient satisfaction, scar length, and scar width.
What the evidence shows
In the pooled analysis, multiple-staged surgery was associated with fewer major wound complications than single-stage surgery, with an odds ratio of 0.54 and a 95% confidence interval of 0.30 to 0.97. Recurrence was also less common in the staged-surgery group, with an odds ratio of 0.45 and a 95% confidence interval of 0.22 to 0.93. Average scars were 0.32 millimeters shorter and 0.04 millimeters narrower with staged surgery. The researchers found no statistically significant difference in cosmetic satisfaction or patient satisfaction. Because the underlying studies were nonrandomized, these results show associations and do not establish that staged surgery itself caused the differences.
Where this may apply
These findings may be most relevant to people similar to those studied: individuals undergoing reconstruction for large or giant congenital melanocytic nevi, or for medium-sized facial lesions in pediatric populations. They should not automatically be generalized to smaller lesions, adults or body locations not represented in the studies, other skin lesions, or other reconstructive conditions. The results describe group-level associations from limited comparative evidence and do not establish which approach is appropriate for any particular person.
What this could mean
The findings provide comparative information about two surgical approaches for congenital melanocytic nevi, particularly the larger or facial lesions represented in the included studies. They suggest that any average difference in scar dimensions may be very small: the authors noted that the width difference could be visually negligible and affected by measurement error. The lack of a clear satisfaction difference also means that statistically detectable differences in complications or scar measurements did not clearly translate into higher reported satisfaction.
Limitations & evidence assessment
The evidence came from only seven studies, all of which were retrospective or otherwise nonrandomized, so differences in the people selected for each surgical approach could have influenced the results. The included techniques were grouped broadly: multiple-staged surgery included staged excision, tissue-expansion-assisted excision, and combined flap methods. The studies differed in lesion type and location, and satisfaction was measured with different subjective scales that were not standardized. The analysis focused mainly on large or giant congenital melanocytic nevi and pediatric facial lesions, so its results may not represent all congenital nevi. The authors also stated that the small scar differences may have limited clinical importance and that higher-quality prospective studies are needed.
Why this evidence level: This meta-analysis combined seven comparative studies involving 578 people, but all included studies were retrospective cohorts or clinical controlled studies rather than randomized trials. The findings are therefore informative but may be affected by differences between patient groups, surgical methods, and outcome measurements.
Evidence levels are editorial estimates derived from study metadata — they are not clinical appraisals.
// Source
Annali Italiani di Chirurgia · 2026 · DOI: 10.62713/aic.4704
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