Should we remove all congenital nevi (CN) regardless of size? I am frequently asked this question by a variety of physicians. I think it is safe to say that there is no universally accepted answer. As recently as the 1984 Annual American Academy of Dermatology meeting, Rhodes and Kopf were on the program to, once again, debate the pros and cons of removal. I have heard it said (tongue in cheek, of course) that matters would be greatly simplified if the two were given dueling pistols and let the outcome dictate policy from then on.
In order to answer the original question in the affirmative, the minimum requirement would be to prove malignant potential for these lesions. That large (>20 cm) CN are melanoma precursors is agreed on by essentially all investigators working in this area.1,2 The magnitude of the risk varies greatly from report to report, but the
Alper JC. Congenital NeviThe Controversy Rages On. Arch Dermatol. 1985;121(6):734-735. doi:10.1001/archderm.1985.01660060048018