Treatment strategies for giant nevi have been controversial in academia, and physicians are not unanimous in their opinions. Some doctors strongly recommend complete removal of the nevus, while others believe that the malignancy rate of giant nevi is so low that complete removal of the nevus is unnecessary. Parents may be unconvinced by this controversy; why not treat it aggressively if it can be completely removed? This controversy exists because complete removal of the nevus comes at a price, such as visible scarring, remaining deformities after reconstruction, not to mention the various complications that may exist with the treatment, and the existing treatment modalities do not exchange for perfect treatment results, sometimes replacing the lesion with a deformity. In addition, even if a nevus is completely removed, there is no guarantee that it will not develop melanocytoma; complete removal only reduces the chance of malignancy. So, does complete excision still make sense? There are indications for complete excision. It is undeniable that complete excision can reduce the chance of malignancy, so there is a very positive side to the treatment. Although a plastic surgeon is not a magician and cannot take a magic eraser and erase the blackness without leaving a trace, the appearance of the treated nevus is certainly improved to a certain extent, which can relieve the psychological stress caused by the abnormal appearance of the child. For the dysfunction caused by the nevus and the recurrent ulceration and itching in the giant nevus, the significance of the treatment cannot be overstated. Based on the above analysis, I strongly agree with the statement that the treatment of giant nevus is an art of finding a balance. Currently, we believe that the best treatment strategy is to actively treat nevi in exposed areas, including the head, face and neck, the distal parts of the upper and lower extremities, such as the forearms, hands, lower legs and feet; for non-exposed nevi, if the nevus has precursor symptoms of malignancy or functional impairment, then treatment is given, otherwise, the nevus is only closely observed and regularly followed up. Time of treatment Many parents may ask when is the right time to treat their children. Again, the timing of treatment for giant nevus is not a simple issue and is controversial. Some doctors recommend treatment after puberty, when the child can cooperate well, while others believe that the earlier the nevus is treated, the better. We believe that the best age for treatment of giant nevus is around three years old, when children can cooperate with some basic surgical treatment, and four-year-olds can usually cooperate with tissue expansion treatment, while most giant nevi need a treatment window of two to three years, and treatment is best completed when children are around six years old, so that school and psychological development of children can not be affected. What treatments are available for nevus? The treatment of giant nevi has been one of the most challenging areas of plastic surgery and has been attempted by doctors from ancient times to the present. Treatments for giant nevi can be roughly divided into excisional and non-excisional methods. Non-excisional methods of treatment include grinding, chemical peels and lasers. These methods have been abandoned by most doctors because they only destroy melanocytes in the superficial layers of the epidermis and dermis, while most melanocytes in giant nevi are found in the dermis. Not only can these methods not completely remove the lesion, but they can also cause severe scarring, and it is hard to say that there is any improvement in appearance, and more importantly, the formation of scarring can make the early diagnosis of malignant changes in giant nevi difficult. Therefore, parents are advised here not to choose these treatments. Excisional treatment Excisional treatment is currently the common method of treatment for giant nevus. There are many methods of excisional treatment, including staged excision, tissue expansion and skin grafting. These techniques are not free to use, but have their own indications, that is, the circumstances in which they are applicable. Fractional excision Fractional excision is an interesting surgical technique in which lesions that cannot be removed in a single procedure can be completely removed in two or three procedures. This technique takes advantage of the stretching elasticity of the skin, it is simple, has few complications, and has many advantages, but due to the large size of giant nevi, fractionated excision is rarely useful, and it is mostly used for the treatment of giant nevi in other areas of satellite nevi. Skin slice grafting Skin slice grafting, also commonly known as skin grafting, is to trim normal skin from other parts of the body and transplant it to the wound formed after removal of giant nevus. This form of skin grafting is not physiological, and the skin loses its normal blood supply during the grafting process, so it survives in a state of lack of nutrition, and the surviving skin fragments will undergo a certain degree of contracture and pigmentation, so the effect of skin grafting is not like normal skin but more like a scar. Skin grafts are used in areas where tissue expansion techniques cannot be used, such as hands, feet, and lower legs, because the repair is not ideal. Tissue expansion Most parents are relatively new to the tissue expansion technique. It is a relatively complex procedure that simply involves placing a balloon-like expander under the skin and periodically filling the expander with water to create tension on the skin as it expands, stimulating skin renewal while mobilizing the surrounding skin to obtain additional skin to cover the giant mole. This is a time-consuming and costly procedure that requires at least two surgeries, each at an interval of 3-6 months. Nevertheless, this technique is still the most effective way to treat giant nevi. The tissue expansion technique can be used in a variety of ways to treat giant nevi. The additional skin that is expanded can be trimmed into skin grafts, used to directly cover adjacent giant nevi, or used to cover distant nevi with vascular free grafts. Tissue expansion is the most ideal method for treating giant nevi on the head, face, neck, and trunk, but it has its own limitations in that if there is no normal skin around the nevus, it cannot be repaired using tissue expansion.