Dermatology Online Journal
- Author(s): Kovich, Olympia
- Hale, Elizabeth K
- et al.
Department of Dermatology, New York University School of Medicine
Olympia Kovich MD, and Elizabeth K Hale MD
Dermatology Online Journal 11 (4): 16
A 35-year-old woman presented with cosmetically disturbing facial plaques, which had been present since birth and were consistent with nevus sebaceus on histopathologic examination. Nevus sebaceus is a congenital, hairless plaque, which is found most commonly on the scalp and face and typically becomes thicker and more verrucous in appearance as the patient enters adulthood. There is an association with benign and malignant neoplasms. Typically, these lesions are either removed surgically or the patients are followed clinically. Other therapeutic modalities utilized for cosmesis include carbon dioxide laser and photodynamic therapy.
A 35-year-old woman presented with a history of a birthmark on her scalp, which extended onto the right side of her face. The affected area has been increasing in size. There are no systemic features to indicate neurologic or ophthalmologic involvement. A biopsy was performed in the past, but the patient was unaware of the diagnosis. Treatment had been pursued in the past with partial excision, laser treatment, and application of acid. The patient was unaware of further details of these therapeutic modalities. An excision of the affected scalp region, which established the diagnosis, was performed by the Plastic Surgery Department at Bellevue Hospital Center. She is interested in further treatment to improve the appearance of the lesion on her face. Curettage of a small area was performed with subsequent recurrence of the lesion at that site. Electrodesiccation was performed at a separate site with acceptable cosmetic results.
|Figure 1||Figure 2|
Brown-orange plaques with a cobblestone surface, some in a linear configuration, were present on the right frontal scalp, forehead, cheek, and chin.
Histopathology reveals a papillated epidermal hyperplasia with prominent sebaceous gland hyperplasia and dilated eccrine glands. Hair follicles are decreased in number.
Nevus sebaceus is a congenital, hairless malformation, which most commonly occurs on the scalp and face and which is distributed along the lines of Blaschko in a linear configuration . Typically the initially yellow-orange plaque thickens and develops a verrucous surface during adolescence. Although rare, some patients with extensive cutaneous lesions may have linear nevus sebaceus syndrome, which is associated with abnormalities of the central nervous system, ophthalmologic and skeletal changes, and malignant conditions . Patients with extensive lesions should be appropriately evaluated to rule out systemic involvement.
A number of benign and malignant conditions have been reported to develop in association with nevus sebaceous; most tumors arise after puberty. Historically, syringocystadenoma papilliferum was thought to be the most common benign adnexal tumor to occur in association with nevus sebaceus, but more recent studies conclude that trichoblastoma occurs with greatest frequency . A retrospective analysis of 658 patients (ages 2-16 years) with nevus sebaceus showed no cases of basal-cell carcinoma . Although the incidence of basal-cell carcinomas has been reported as 10 percent, further studies indicate that the true incidence is less than 1 percent .
Although otherwise asymptomatic, concern regarding the occurrence of malignant neoplasms raises the question of prophylactic surgical removal versus treatment solely for cosmesis. The literature suggests that prophylactic surgical removal is not required but is suggested when there is a high degree of suspicion for benign or malignant neoplasms or for cosmesis [3, 4]. In some patients, surgical removal is not a viable alternative, owing to the extent of the lesion and the areas affected. Although other nonsurgical, therapeutic modalities have been utilized, some authors disagree with this practice as it may impede the detection of malignant neoplasms . Nevertheless, it appears that these other modalities may be the only option for cosmesis in some patients. One case report describes a patient with a linear nevus sebaceus of the face treated with a carbon dioxide laser with an improvement in the cosmetic appearance . Another case report describes the utilization of photodynamic therapy with topical aminolevulinic acid and clinical resolution of the nevus sebaceus after thirteen treatment sessions .
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