Congenital Hairy Nevi

Congenital hairy nevi in this location are often associated with-and act as signs of-abnormalities of the vertebrae, spinal cord or both.

An obese, 24-year-old woman presented for laser hair removal from 2 spots on the lower back. A very directed review of systems revealed some lower back pain that radiated down her right leg, suggestive of a radiculopathy. The patient denied lower extremity weakness.

Key point: The patient clearly has congenital hairy nevi. While there is some small concern about neoplastic transformation, the more realistic worry revolves around the lesion located directly in the midline. Congenital hairy nevi in this location are often associated with-and act as signs of-abnormalities of the vertebrae, spinal cord or both (eg, spina bifida).

Treatment: Hair removal was done after radiologic imaging was performed.

Note: CT scan and/or MRI may be used to investigate the lower spinal column. Bony or neurologic abnormalities found are often correctable.