# Surgical management of large facial congenital melanocytic nevi using Ahmad technique: a case report

## TL;DR

A 9-year-old girl with a large facial birthmark underwent a new four-stage surgical technique that successfully removed the nevus and improved her appearance and mental well-being.

## Contribution

The paper introduces the 'Ahmad Technique,' a novel four-stage surgical approach for removing large facial congenital melanocytic nevi.

## Key findings

- The Ahmad Technique successfully removed a large facial nevus in four stages using tissue expansion and partial excisions.
- The patient achieved excellent aesthetic and psychological outcomes after the procedure.
- Histopathology confirmed the benign nature of the nevus throughout the treatment.

## Abstract

We report the case of a 9-year-old girl with a large congenital hairy pigmented nevus on her left cheek causing psychological distress. A novel and promising surgical method called the ‘Ahmad Technique,’ named after the author of this manuscript, was employed. This approach uses a single tissue expander in a structured four-stage treatment plan. Initially, a 30 ml subcutaneous expander was inserted via a preauricular incision and gradually inflated every 10 days over 4 months. After complete deflation, a partial excision of the nevus was performed, with histopathology confirming a benign intradermal melanocytic nevus. Following wound healing, tissue expansion resumed for another four months. The third stage included a second partial excision followed by a final expansion phase. In the fourth stage, complete excision of the nevus and expander capsule was done, and reconstruction used the expanded skin flap. The patient achieved excellent aesthetic and psychological outcomes, confirming the Ahmad Technique as a safe, effective, and innovative option for complex facial congenital melanocytic nevi.