Since birth, Ngan has had raised lesions, primarily on the right side of her body, from her head, neck, shoulders, back, arms, and buttocks down to her legs and groin. As she grew, these lesions developed into large, dark brown patches, rough to the touch like "toad skin". Ngan underwent several surgeries to remove the growths, but they recurred in the same areas.

This time, Dr. Hoang Thi Phuong Lan of the Department of Trauma and Orthopedics at Tam Anh General Hospital in Hanoi diagnosed Ngan with epidermal nevus, a congenital skin condition caused by abnormal epidermal cell differentiation, sometimes linked to gene mutations or HPV infection.

According to medical literature, epidermal nevus occurs in about 1 in 1,000 newborns, usually appearing at birth or during early childhood. There are several forms of the condition, with the warty type being the most common. While usually benign, extensive lesions, especially in sensitive areas like the groin or perianal region, can cause pain, inflammation, or affect other organs if it's a disseminated epidermal nevus syndrome.

"Ngan's case is a rare and complex congenital giant epidermal nevus," Dr. Lan said, adding that the extensive lesions and previous surgeries made treatment and cosmetic reconstruction challenging.

Dr. Hoang Thi Phuong Lan examining and advising a patient. Illustrative photo: *Tam Anh General Hospital*

Her treatment was individualized and divided into phases, aiming to both remove the lesions and restore her appearance through a multi-pronged approach. In the first phase, doctors removed a large, unsightly 20-cm scar on her right elbow. The surgical team used skin flap reconstruction combined with meticulous hemostasis and multi-layered suturing to minimize scarring.

The skin lesions on her neck, right arm, groin, and right leg were treated with high-tech laser technology. This method allowed for precise layer-by-layer removal of the nevi, minimizing bleeding and damage to healthy tissue. After the procedure, the treated areas were dressed with antibiotic ointment, and Ngan received detailed care instructions to reduce the risk of recurrence and dark scarring.

Ngan recovered well after surgery and was discharged after three days. The incisions were clean, dry, and painless. She was given a long-term treatment plan, which includes follow-up surgeries every 3-6 months to completely remove all lesions and scars.

Dr. Lan emphasized that giant epidermal nevus is a complex condition requiring diagnosis and treatment at medical facilities with specialized plastic and reconstructive surgery departments. Inappropriate or incorrectly performed surgery can fail to resolve the issue and lead to severe consequences.

Thanh Ba