Purpose

A divided nevus, also known as a kissing nevus, is a congenital melanocytic nevus that develops during fetal development when the upper and lower eyelids are fused and subsequently separated with the formation of the palpebral fissure. Although it is benign, it may cause both functional and cosmetic impairment, often necessitating surgical excision. Here we report four surgically treated cases with favorable outcomes.

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Methods

This case series included four patients. Patient 1 was a 52-year-old woman who presented with a congenital pigmented lesion involving the medial parts of her right upper and lower eyelids, which had gradually enlarged over 5 years. Serial excisions were performed along the lid margin while preserving the eyelash roots.
Patient 2 was a 31-year-old woman with a congenital nevus on the left upper eyelid that had gradually enlarged over 10 years. Serial shaving excisions were performed.
Patient 3 was a 61-year-old woman who underwent bilateral ptosis repair and the excision of a divided nevus with skin grafting. Postoperatively, trichiasis developed, necessitating the additional excision of the eyelash roots.
Patient 4 was a 33-year-old woman who presented with a congenital nevus on the right upper and lower eyelids and epiblepharon. Serial shaving excisions were performed with simultaneous correction of upper and lower eyelid epiblepharon using a modified Hotz procedure.

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Results

All four cases achieved significant functional and cosmetic improvement after tumor excision. No meibomian gland dysfunction was observed following eyelid margin excision, although postoperative eyelash loss occurred only in Patient 1.

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Conclusion

A divided nevus can cause significant functional and cosmetic disturbances. Although surgical excision carries risks such as trichiasis and lagophthalmos, it generally results in high patient satisfaction. We achieved favorable postoperative outcomes in all four cases.

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Additional Authors

First name	Last name	Base Hospital / Institution
Shohei	Suetake	Sapporo Medical University Hospital
Ryo	Kikuchi	Oculofacial Clinic Chiba
Tomoyuki	Kashima	Oculofacial Clinic Tokyo

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