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I would like to thank Dr Virginia Sybert for her excellent letter—particularly since it validates my choice of title for the editorial.I accept all of Virginia's criticisms concerning the study by Rhodes et al as causing potential serious flaws. However, that does not necessarily make the data worthless. It is possible, with an ideally designed study, that the magnitude of the risk would be less, but that small congenital nevi would still have a malignant transformation rate greater than that of acquired nevi. Or, perhaps, such an ideally designed study would finally show that there is no risk at all. At present, we do not know. But neither do we know that the flaws in the study by Rhodes et al totally negate their conclusions. Therefore, I still find it prudent to remove small congenital nevi as soon after birth as possible given that (1) the procedure is essentially
Alper JC. Congenital Nevi: The Controversy Rages On-Reply. Arch Dermatol. 1986;122(5):503. doi:10.1001/archderm.1986.01660170027005