Surgical Management of Cutaneous Melanocytic Nevi: Clinicopathological Findings and Outcomes from a Tertiary Plastic Surgery Center in Baghdad, Iraq

Abstract

It was a prospective, single-centered observational study of 320 patients who had cutaneous pigmented moles that underwent surgery at Ghazi Al-Hariri Hospital of Surgical Specialties, Baghdad Medical City, during the period between January 2022 and December 2023. The handheld polarized dermoscopy and ABCDE dermoscopic criteria were used together to make the preoperative assessment. WHO Skin Tumour Classification (5th edition, 2022) was used to assess the histopathology. Extended the follow-up to 12 months. The histopathology showed 278 benign nevi (86.9) and 42 premalignant or malignant lesions (36 dysplastic nevi, 6 melanoma (4 in situ, 2 invasive). The main anatomical location was the face (41.3%), and the next was the trunk (30.6%). The preoperative clinical -dermoscopic evaluation had a general concordance percentage of 89.4 with histopathology, sensitivity of 85.7 percent in the malignancy detection and specificity percentage of 97.1. Primary closure on an elliptical excision was done in 94.1 percent of cases. In 5.6% of patients there were postoperative complications which were mostly superficial infections and hypertrophic scarring. In 12-month follow-up, one case of invasive melanoma was registered. Cosmetic patient satisfaction was more than 82%. These results suggest that a combination of structured clinical assessment and dermoscopy and histopathological confirmation allows safe and effective excision of moles in a resource-constrained Iraqi context, and aids in the development of national guidelines on the management of pigmented lesions.