Derm Dx: A waxy, yellowish plaque since birth - Clinical Advisor

Derm Dx: A waxy, yellowish plaque since birth

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A 3-month-old male presents with a scalp lesion since birth. The child is normal developmentally, and his parents deny any history of genodermatoses or similar growths. Examination of the affected area reveals a 3-cm flesh-colored plaque with a yellowish hue and waxy surface texture. No other skin abnormalities are detected on physical examination.

Nevus sebaceous is a benign hamartoma that was first described by the German dermatologist Josef Jadassohn in 1895. The condition presents as a waxy, non-hair-bearing yellowish or orange patch or plaque on the scalp or face. Lesions are usually present...

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Nevus sebaceous is a benign hamartoma that was first described by the German dermatologist Josef Jadassohn in 1895. The condition presents as a waxy, non-hair-bearing yellowish or orange patch or plaque on the scalp or face. Lesions are usually present at birth, and over time, the nevus becomes thicker and more verrucoid in appearance. The condition is not usually associated with other defects; however, a rare variant known as linear nevus sebaceous syndrome includes seizures and ophthalmologic and skeletal changes.1

A variety of tumors may result from nevus sebaceous and will become evident after puberty.2 Among the most common are syringocystadenoma papilliferum, trichoblastoma, and basal cell carcinoma.3 Management of nevus sebaceous entails either observation or excision. Excision is often performed for cosmesis and/or because of the unlikely risk for malignant transformation,4 which occurs in a small percentage of cases.5


Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania.

References

  1. Herman TE, Siegel MJ. Hemimegalencephaly and linear nevus sebaceous syndrome. J Perinatol. 2001;21:336-338.
  2. Kaddu S, Schaeppi H, Kerl H, Soyer HP. Basaloid neoplasms in nevus sebaceus. J Cutan Pathol. 2000;27:327-337.
  3. Idriss MH, Elston DM. Secondary neoplasms associated with nevus sebaceous of Jadassohn: a study of 707 cases. J Am Acad Dermatol. 2014;70:332-337.
  4. Santibanez-Gallerani A, Marshall D, Duarte AM, Melnick SJ, Thaller S. Should nevus sebaceus of Jadassohn in children be excised? A study of 757 cases, and literature review. J Craniofac Surg. 2003;14:658-660.
  5. Hsu MC, Liau JY, Hong JL, et al. Secondary neoplasms arising from nevus sebaceus: a retrospective study of 450 cases in Taiwan. J Dermatol. 2016;43:175-180.
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