Derm Dx: Asymptomatic Filiform Plaque on the Scalp - Clinical Advisor

Derm Dx: Asymptomatic Filiform Plaque on the Scalp

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A 76-year-old man presents with a growth on his scalp. He denies history of skin cancer and is in good health. The patient states that the lesion has been present for “as long as he can remember.” The growth is asymptomatic although occasionally traumatized when he combs his hair. Examination reveals a 2.0-cm flesh-colored plaque with filiform projections. No similar lesions are noted elsewhere.

Can you diagnose this condition?

Nevus sebaceous (also known as nevus sebaceous of Jadassohn) is a benign hamartoma that most commonly presents as a waxy yellow- to orange-colored patch or plaque on the scalp or face. Lesions are present at birth or arise in early...

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Nevus sebaceous (also known as nevus sebaceous of Jadassohn) is a benign hamartoma that most commonly presents as a waxy yellow- to orange-colored patch or plaque on the scalp or face. Lesions are present at birth or arise in early childhood. The nevus develops a verrucoid appearance over time and remains devoid of hair. The condition usually is not associated with other findings; a rare variant known as linear nevus sebaceous syndrome is accompanied by seizures and ophthalmologic and skeletal changes.1

A variety of tumors that first become evident after puberty may arise from nevus sebaceous.2 Among the most common are syringocystadenoma papilliferum, trichoblastoma, and basal cell carcinoma.3 Treatment involves either observation or excision, the latter performed primarily for cosmesis given that the risk for malignant transformation is low.4,5  Alternative therapies such as laser ablation and dermabrasion are discouraged as these procedures do not completely eliminate the lesion.6

Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.

References

1. Herman TE, Siegel MJ. Hemimegalencephaly and linear nevus sebaceous syndrome. J Perinatol. 2001;21(5):336-338.  

2. Kaddu S, Schaeppi H, Kerl H, Soyer HP. Basaloid neoplasms in nevus sebaceus. J Cutan Pathol. 2000;27(7):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(2):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. Craniofacial Surg. 2003;14(5):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(2):175-180.  

6. Paninson B, Trope BM, Moschini JC, Jeunon-Sousa MA, Ramos-E-Silva M.  Basal cell carcinoma on a nevus sebaceous of Jadassohn: a case report.J Clin Aesthet Dermatol. 2019;12(3):40-23.

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