A Boy with a Bald Spot on his Scalp, Returns
The lesion, seen first more than 10 years ago, is larger and has changed. It has not been followed. Your Dx? Next steps?
Dr Jonathan Schneider reviews a case here from his days as a Navy doctor. A patient he saw as a baby returns, with his family, as a young teen. A scalp lesion noted early in the boy's life is still present and has grown in size. The mother is concerned because a) the lesion has gotten worse, and, b) she had been advised when it was first detected, to have it removed before the boy reached puberty. He is 13-years-old.
What is your diagnosis of the expanding growth?
How would you advise mother and son to proceed at this point?
Patient was seen as a baby more than 13 years ago for scalp lesion. Family move brings him back to your practice; otherwise well, vaccinations current, but scalp lesion persists.
Scalp lesions not followed for a decade and have grown. Mother is concerned since physician had suggested when patient was a child that they be removed in early childhood/prior to adolescence.
Original appearance of lesion: 2-cm yellowish-orange, linear plaque-like lesion near scalp vertex. Smooth, devoid of hair; classic characteristics for the diagnosis.
Current appearance of lesion: Now 13-years-old, appears warty/verrucous, more nodular. Linear; length increased from 2 cm to nearly 6 cm. Solitary and sole lesion on patient's body.
Differential diagnosis:Aplasia cutis congenital, triangular alopecia, epidermal nevus syndrome, nongenital warts, seborrheic keratosis, nevus sebaceous, juvenile xanthogranuloma, congenital molluscum contagiosum.
Diagnosis: F. Nevus sebaceous of Jodassohn. What is the most appropriate treatment?
Nevus sebaceous treatment: Malignant degeneration is rare. Monitor (by PCP and/or dermatologist). Excise lesion if signs of malignant change or for cosmetic reasons.
Patient outcome: Opted for no treatment, continue to follow; covered bald spot with hair; resisted annual surveillance.
Nevus sebaceous is a hamartoma. In this patient it involves pilosebaceous–apocrine unit in the scalp; can occur anywhere in the presence of sebaceous glands.
Nevus sebaceous, typical stages: growth accelerates in adolescence; sebaceous glands multiply, apocrine glands become hyperplastic, cystic; the lesion becomes verrucous.
Nevus sebaceous prognosis: Malignant changes are rare. Historically thought to be 10-15%; rate now known to be very low. Most common: benign, trichoblastoma; malignant, basal cell carcinoma
Dr Jonathan Schneider reviews a case here from his days as a Navy doctor. A patient he saw as a baby returns, with his family, as a young teen. A scalp lesion noted early in the boy's life is still present and has grown in size. The mother is concerned because a) the lesion has gotten worse, and, b) she had been advised when it was first detected, to have it removed before the boy reached puberty. He is 13-years-old.What is your diagnosis of the expanding growth? How would you advise mother and son to proceed at this point?        Resources (in alphabetical order)- Ankad BS, Beergouder SL, Domble V. Trichoscopy: The best auxiliary tool in the evaluation of nevus sebaceous. Int J Trichology. 2016;8: 5â10.- Cribier B, Scrivener Y, Grosshans E. Tumors arising in nevus sebaceous: A study of 596 cases. J Am Acad Dermatol. 2000;42(2 Pt 1):263-8.- Falto-Aizpurua LA, Griffith RD, Nouri K. Josef Jadassohn A dermatologic pioneer. JAMA Dermatol. 2015;151:41. doi:10.1001/jamadermatol.2014.3187.- Jaqueti G, Requena L, Sanchez Yus E. Trichoblastoma is the most common neoplasm developed in nevus sebaceus of Jadassohn: a clinicopathologic study of a series of 155 cases. Am J Dermatopathol. 2000;22:108-18.- Leung AKC and Barankin B. Nevus Sebaceous. Austin J Pediatr. 2014;1:1006.- Miller CJ, Ioffreda MD, Billinglsey EM. Sebaceous carcinoma, basal cell carcinoma, trichoadenoma, trichoblastoma, and syringocystadenoma papilliferum arising within a nevus sebaceus. Dermatol Surg. 2004;30:1546â1549.- Moody MN, Landau JM, Goldberg LH. Nevus sebaceous revisited. Pediatr Dermatol. 2012;29:15â23.- Namiki T, Miura K, Ueno M. Four different tumors arising in a nevus sebaceous. Case Rep Dermatol. 2016 Jan-Apr; 8(1): 75â79.
