furthermore , the site of lesion could indicate surgical excision to prevent continuous microtraumas [ 13 ] . surgical excision could determine loss of substance due to the dimension of the nevus that could not be easily directly repaired . the foreskin is a good autologous full - thickness skin graft in several conditions . the authors report the use of foreskin as skin graft to repair a loss of substance due to excision   of an interdigital nevus of the foot . a four - year - old boy presented a 2  cm  1.5  cm congenital compound nevus entirely covering the plantar surface of the second finger of his left foot ( figure 1 ) . paediatric dermatologist 's indication was a radical excision because of the site and the dimension of this melanocytic lesion . primary closure of the skin defect secondary to radical excision of the lesion was not indicated because of the large loss of substance and the risk of retractive scar . then we performed circumcision and a radical excision of the nevus ( figure 3(a ) ) ; foreskin , trimmed in a rectangular shape ( figure 2 ) , was sutured into the residual defect ( figure 3(b ) ) . , the patient has normal use of the foot finger with no evidence of contracture ( figure 4 ) . congenital melanocytic nevus is a frequent condition in childhood ( 0,21% ) [ 1 , 2 ] . the role of these lesions in increasing incidence of cutaneous melanoma is discussed and the prophylactic removal of all congenital melanocytic nevi is not supported : however , the most congenital melanocytic nevi are removed on preventing criteria . the selective excision   of suspicious nevi is indicated when the features of a possible malignancy are faced . these features can include change in size or colour , irregular borders , or development of ulcerations . other features that can justify excision are site and extension of the lesion , multinodular aspect ,   and the presence of other risk factors ( immunodeficiency , dysplastic nevus syndrome , and xeroderma pigmentosa ) . excision of larger lesions require the use of local plasty , free tissue skin graft , or even the prior use of a tissue expander .graft should be harvested from hairless areas where the skin is redundant ( groin , volar wrist crease , volar elbow crease , and ulnar side of the hypothenar eminence ) . foreskin as a source of skin graft   most often been used in urethral reconstruction for congenital or acquired penile defects [ 5 , 6 ] , in burn reconstruction , most commonly for eyelid resurfacing   , and in syndactyly repair [ 9 , 10 ] . newborn circumcision remains controversial ; this procedure has potential medical advantages ( decreased risk of cancer of the penis and urinary tract infections ) as well as disadvantages and risks ( bleeding , infection , meatitis , and scarred phimosis ) .   in italy , neonatal circumcision is not routinely performed ; this intervention is electively carried out until three years of age to repair congenital phimosis and at all ages in cases of scarred phimosis , recurrent balanoposthitis , and urinary infections . therefore foreskin is frequently available as tissue graft in paediatric population .   in our case , dimension and   site ( difficult to control ) of melanocytic foreskin was available because the boy was also affected by congenital phimosis , so we did not look for another source of skin graft . the most common problem reported after the use of prepuce as donor skin is hyperpigmentation . in our case , hyperpigmentation was not a contraindication for the use of foreskin as skin graft because the lesion was hidden localizated . foreskin provides a skin of good elastic quality avoiding secondary retraction with a favourable rate of graft intake . therefore , this source of graft gives the advantage of the absence of scar prejudice at the donor site .
we report a four - year - old boy with a   nevus covering all the plantar side of his second finger on the left foot . 
 he was also affected by congenital phimosis . 
 surgical excision of the nevus was indicated , but the skin defect would have been too large to be directly closed . 
 the foreskin was taken as a full - thickness skin graft to cover the cutaneous defect of the finger . 
 the graft intake was favourable and provided a functional repair with good aesthetic characteristic .