Surgical management of large facial congenital melanocytic nevi using Ahmad technique: a case report

Abstract

We report the case of a 9-year-old girl with a large congenital hairy pigmented nevus on her left cheek causing psychological distress. A novel and promising surgical method called the 'Ahmad Technique,' named after the author of this manuscript, was employed. This approach uses a single tissue expander in a structured four-stage treatment plan. Initially, a 30 ml subcutaneous expander was inserted via a preauricular incision and gradually inflated every 10 days over 4 months. After complete deflation, a partial excision of the nevus was performed, with histopathology confirming a benign intradermal melanocytic nevus. Following wound healing, tissue expansion resumed for another four months. The third stage included a second partial excision followed by a final expansion phase. In the fourth stage, complete excision of the nevus and expander capsule was done, and reconstruction used the expanded skin flap. The patient achieved excellent aesthetic and psychological outcomes, confirming the Ahmad Technique as a safe, effective, and innovative option for complex facial congenital melanocytic nevi.

Keywords: Ahmad technique; congenital melanocytic nevus; facial reconstruction; tissue expansion.

Figure 1

(A) Patient photograph (frontal view). (B) Patient photograph (lateral view). (C) Patient photograph after full expansion of the tissue expander (frontal view). (D) Patient photograph after full expansion of the tissue expander (lateral view).

Figure 2

(A) Patient appearance prior to the third surgical stage. (B) Surgical incision site. (C) Operative field at the end of the third surgical procedure. (D) Lateral view of the patient prior to the final surgical stage.

Figure 3

(A) Intraoperative view showing complete excision of the nevus and removal of the tissue expander. (B) Lateral view of the patient at the completion of the final surgical stage. (C) Postoperative view of the patient after removal of surgical sutures. (D) Postoperative view of the patient six months after surgery.