Use of Preputial Skin as Cutaneous Graft after Nevus Excision

We report a four-year-old boy with a nevus covering all the plantar side of his second finger on the left foot. He was also affected by congenital phimosis. Surgical excision of the nevus was indicated, but the skin defect would have been too large to be directly closed. The foreskin was taken as a full-thickness skin graft to cover the cutaneous defect of the finger. The graft intake was favourable and provided a functional repair with good aesthetic characteristic. 1. Introduction In order to prevent melanoma, selective removal of suspicious nevi is indicated. Furthermore, the site of lesion could indicate surgical excision to prevent continuous microtraumas [1–3]. Surgical excision could determine loss of substance due to the dimension of the nevus that could not be easily directly repaired. The foreskin is a good autologous full-thickness skin graft in several conditions [4]. The authors report the use of foreskin as skin graft to repair a loss of substance due to excision of an interdigital nevus of the foot. 2. Case Presentation A four-year-old boy presented a 2？cm 1.5？cm congenital compound nevus entirely covering the plantar surface of the second finger of his left foot (Figure 1). Paediatric dermatologist’s indication was a radical excision because of the site and the dimension of this melanocytic lesion. Primary closure of the skin defect secondary to radical excision of the lesion was not indicated because of the large loss of substance and the risk of retractive scar. A skin graft was necessary to perform the repair. Figure 1: Site and features of the congenital compound nevus. The boy was also affected by congenital phimosis which required circumcision. So we decided to take foreskin as an autologous full-thickness skin graft. Then we performed circumcision and a radical excision of the nevus (Figure 3(a)); foreskin, trimmed in a rectangular shape (Figure 2), was sutured into the residual defect (Figure 3(b)). An occlusive medication was placed and removed ten days after. Figure 2: Foreskin trimmed in a rectangular shape. Figure 3: Residual open area after excision of the nevus (a) and foreskin graft sutured to cover the cutaneous defect (b). Postoperatively the skin graft healed well. Today, one year after the operation, the patient has normal use of the foot finger with no evidence of contracture (Figure 4). Figure 4: Delayed postoperative result (1 year after intervention). 3. Discussion Congenital melanocytic nevus is a frequent condition in childhood (0,2–1%) [1, 2]. The role of these lesions in increasing incidence of cutaneous