Multiple-staged excision reduces major wound complications and recurrence in congenital melanocytic neviMultiple staged excision reduces complications for congenital melanocytic nevi

AIM: Systematic evidence comparing multiple-staged and single-stage excision strategies for the excision and reconstruction of congenital melanocytic nevi (CMN) remains limited. Because direct comparative evidence remains scarce, we pooled available studies to determine whether multiple-staged excision differs from single-stage excision in postoperative complications, recurrence, scar outcomes, and satisfaction after CMN reconstruction. METHODS: To retrieve comparative evidence on surgical strategies for CMN, a systematic literature search was conducted across PubMed, Embase, the Cochrane Library, Web of Science, CNKI, VIP, and Wanfang databases. The retrieval covered all records available from the establishment of each database through 31 October 2025. The prespecified outcomes were major wound complications, lesion recurrence, cosmetic satisfaction, patient satisfaction, postoperative scar length, and scar width. After eligible studies were selected, relevant data were extracted, methodological quality was assessed, and quantitative synthesis was carried out using Review Manager (version 5.3, Cochrane Collaboration). RESULTS: Seven retrospective cohort studies or clinical controlled studies were included, involving a total of 578 patients. Compared with single-stage excision, multiple-staged excision was associated with a significantly lower incidence of major wound complications (odds ratio (OR) = 0.54, 95% CI 0.30-0.97, = 0.04), lower recurrence rate (OR = 0.45, 95% CI 0.22-0.93, = 0.03), shorter scar length (MD = -0.32 mm, 95% CI -0.52 to -0.12, = 0.002), and narrower scar width (MD = -0.04 mm, 95% CI -0.09 to -0.01, = 0.04); the upper limit of the 95% CI was rounded to 0.00 by RevMan, while the unrounded value remained below zero. No significant differences were observed between the two groups in cosmetic satisfaction (OR = 1.07, 95% CI 0.64-1.79, = 0.80) or patient satisfaction (OR = 1.29, 95% CI 0.51-3.29, = 0.59). CONCLUSIONS: This meta-analysis demonstrates that multiple-staged excision significantly reduces the incidence of major wound complications, recurrence rate, and scar dimensions compared with single-stage excision, while showing no significant difference in satisfaction outcomes. These findings suggest that multiple-staged excision may offer advantages in safety and efficacy in the excision and reconstruction of CMN and could be considered a valuable surgical strategy in appropriate clinical settings.