Almost everyone has pigmented moles. Pigmented moles that are very small and superficial in size are harmless and often go unnoticed; if they grow on important parts of the face and neck or are larger in size, they are often a cause for concern. Pigmented nevus is a common benign tumor containing pigmented nevus cells, mostly found on the skin and occasionally on the surface of mucous membranes, and can appear at birth or at any time thereafter, on any part of the body. They can be classified as intradermal nevus, junctional nevus, mixed nevus, etc. They are mostly brown or black in color. Larger pigmented nevi on the face and neck are often congenital, and the lesions develop slowly after birth, such as increasing in size, deepening in color, and hair growth, etc., which adversely affects the appearance of the child and even affects the child’s psychological development and self-confidence, and some lesions have a certain risk of malignant transformation, and surgical removal of the lesions is often the only treatment. For larger lesions (1-3 cm in width), if the lesion is completely excised and sutured directly in one operation, it may lead to deformation of local tissues due to tension pulling, poor healing and even necrosis of the skin edge, resulting in obvious postoperative scarring, misalignment and deformation of adjacent organs (such as eyes, nose, mouth and lips) and even affecting the function, etc., with poor results; while repair by local flap transfer will leave more scarring due to additional incisions. The use of free full-thickness flap graft is not ideal for postoperative color, texture, sensation and scarring, and the donor area of the skin is not good after healing. Plastic surgery focuses on the unity of appearance and function, with fine surgical techniques and better postoperative results. Therefore, surgical removal of pigmented nevi in important appearance areas such as the face and neck is generally performed in plastic surgery. For large and moderate sized pigmented nevus (lesion width is about 1-3cm), we recommend to adopt the staged multiple excision method for plastic surgery as appropriate. Staged multiple excision method 1.Definition To achieve complete excision and repair of benign skin lesions that cannot or are not suitable for direct excision and suture repair at one time through multiple smaller excision and suturing, with a small scar and good results. 2.Principle Through each moderate amount of partial excision suture and time interval to continuously mobilize and expand the normal skin around the lesion, so as to repair the larger defect. 3.Rough surgical steps Pre-operative diagnosis: Excluding malignant manifestations according to medical history and physical signs. Surgical design: according to the location, size, shape of pigmented nevus, adjacent relationship with surrounding organs, local skin tension and other factors, the number of safe and efficient excisions (generally 2-3 times) is expected, the area, shape and axial direction of the first excision within the lesion boundary (part) is designed (integrating local skin pattern, contour line of facial part area, lesion long axis direction and other factors), and the final scar location and direction are expected, etc. First surgery: According to the preoperative design and adjusted intraoperatively, the lesion is excised within the boundaries of the appropriate area and the wound is sutured, using the delicate surgical methods of plastic surgery. Re-operation: It usually takes 3-6 months after the last surgery, after the scar in the operated area has matured and softened, and the surrounding skin has relaxed without obvious stretching and deformation, the next excision will be designed again according to the above principles. The last surgery: preoperative design, complete and fine excision of the lesion and repair of the wound so that the final suture wound (future scar) is as short, properly oriented and hidden as possible. The excised lesion must be examined pathologically after each operation, and if there are any abnormalities, the treatment plan is changed according to the results. The stitches are usually removed about 7 days after each operation. 4. Advantages (1) Each operation and anesthesia is simple, with little trauma and quick recovery. (2) No additional surgical incisions are needed, leaving less scarring and good results in final appearance improvement. (3) For pediatric and adolescent patients, fractional excision has less impact on growth and development. (4) Students can take advantage of the summer and winter vacations in school without interfering with their studies. (5) In addition to pigmented nevi, staged multiple excision surgery is also suitable for plastic repair of other benign skin lesions, such as flat superficial scar, warty nevus, etc. 5.Disadvantages The number of surgeries is large and the treatment period is long. In addition, it should be noted that the pathological examination of the lesion specimens excised from each surgery (especially the first surgery) is very important, and if there are abnormalities (including malignant changes), the treatment plan needs to be adjusted at any time; pediatric patients need to adjust the plan according to the specific situation during the treatment process as time passes and development. In conclusion, plastic surgery is an ideal treatment option for staged multiple excision and repair of benign skin lesions of appropriate size on the body surface, including pigmented nevi, verrucous nevi, and flat superficial keloids, in areas such as the face and neck.