The surgical management and outcomes of kissing nevi of the eyelids

Abstract

Purpose: To describe the clinical characteristics, surgical technique, and outcomes in patients with kissing nevi who underwent surgical management in two tertiary referral centers.

Methods: Medical chart review was conducted for all patients who underwent surgical repair in Moorfields Eye Hospital and The Children's Hospital of Philadelphia. Demographics, medical history, lesion characteristics, surgical intervention, and outcomes were collected. Main outcome measures were surgical interventions as well as functional and cosmetic outcomes.

Results: Thirteen patients were included. Mean age at presentation was 23.46 years (±19.35,4-61), and the mean number of surgeries per patients was 1.9 (±1.3,1-5). Initial procedure included incisional biopsy in three cases (23%) and complete excision and reconstruction in 10 cases (77%). Surgery involved the upper and lower anterior lamella in all cases, the upper posterior lamella in 4 patients (31%), and the lower posterior lamella in 2 patients (15%). Local flaps were utilized in 3 cases and grafts in 5 cases. Complications included: trichiasis (n = 2, 15%), lower eyelid ectropion (n = 2, 15%), mild ptosis (n = 1, 8%), and upper/lower punctal ectropion (n = 1, 8%). Twelve patients (92%) were satisfied with the final functional and cosmetic outcome. No recurrence or malignant transformation were observed in any patient.

Conclusion: The surgical management of kissing nevi can be challenging, and commonly includes the use of local flaps or grafts, often requiring multiple interventions. The approach should be based on lesion size and location, proximity and involvement of key anatomical landmarks, as well as individual facial characteristics. Surgical management has a favorable functional and cosmetic outcome in the majority of patients.

Fig. 1. A 21-year-old lady who has a “Kissing nevus” since birth.

The upper lid is cosmetically relatively acceptable, but the lower lid nevus is densely pigmented with involvement of the posterior lamella (A, B). The lower eyelid nevus was excised from the lower anterior lamella. It was reconstructed with skin graft taken from the post-auricular skin with a good cosmetic result (C, D).

Fig. 2. At the age of 4, this patient had extensive involvement of the lids by a congenital nevus.

A, B The patient had excision and skin grafting procedures, but nevus remained at the lid margins (C). The lid margin nevus was resected because of suspicious areas of black pigmentation. The specimen from the upper lid is positioned for pathology. The lesion was read as benign (D). The upper lid is repaired with a free tarsoconjunctival graft with a skin flap from the upper lid. The lower lid margin is left open to heal after the lid margin nevus was contoured using a Colorado cauter (E,F). A good cosmetic result was at the end of follow up (G).

Fig. 3. A 5-year-old patient with temporal kissing nevus that underwent reconstruction using skin graft and local advancement flap.

A 5-year-old patient with left temporal kissing nevus (A, B). The nevus was excised from the upper and lower anterior lamella and lid margin (C). The upper eyelid defect was reconstructed using skin graft taken from the ipsilateral upper eyelid, and the lower defect using local advancement flap from cheek (D, E). (F).