Derm Dx: An asymptomatic papule on the thigh

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A 55-year-old woman seeks consultation for a lesion on her left thigh. The lesion has been present for at least 1 year. She has a history of basal cell carcinoma. The growth is asymptomatic and has never bled. Examination reveals a 0.7-cm flesh-colored papule. Also noted is a dermatofibroma and scattered seborrheic keratosis.

Nevus lipomatosus superficialis (NLS) is an uncommon benign tumor definitively diagnosed by histology. The lesion presents as a soft, flesh-colored to yellowish papule or plaque. The most commonly affected sites are the lower back, upper thighs, and abdomen.NLS was first...

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Nevus lipomatosus superficialis (NLS) is an uncommon benign tumor definitively diagnosed by histology. The lesion presents as a soft, flesh-colored to yellowish papule or plaque. The most commonly affected sites are the lower back, upper thighs, and abdomen.

NLS was first described in 1921 by Hoffmann and Zurhelle.1 The lesion is composed of fat cells within the dermis unattached to subcutaneous adipose tissue.2

 

Two subtypes have been defined. The classic variant is characterized by multiple lesions that arise within the first 2 to 3 years of life and often in a unilateral distribution, whereas the solitary type arises in middle-aged to elderly individuals.2

Surgical excision is curative. Interestingly, injection of NLS with the fat-dissolving agent phosphatidylcholine has resulted in clinical and histopathological resolution.3,4

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. Hoffmann E, Zurhelle E. Über einen Naevus lipomatodes cutaneous superficialis der linken Glutaalgegend. Arch Dermatol Syphilol. 1921;130:327-333.
  2. Jones EW, Marks R, Pongsehirun D. Naevus superficialis lipomatosus: A clinicopathological report of twenty cases. Br J Dermatol. 1975;93(2):121-133.
  3. de Paula Mesquita T, de Almeida HL Jr, de Paula Mesquita MC. Histologic resolution of naevus lipomatosus superficialis with intralesional phosphatidylcholine. J Eur Acad Dermatol Venereol. 2009;23(6):714-715.
  4. Kim HS, Park YM, Kim HO, Lee JY. Intralesional phosphatidylcholine and sodium deoxycholate: A possible treatment option for nevus lipomatosus superficialis. Pediatr Dermatol. 2012;29(1):119-121. 
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