Nevus sebaceus

Published on 19/03/2015 by admin

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Last modified 22/04/2025

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Nevus sebaceus

Stuart R. Lessin and Clifford S. Perlis

Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports

image

Nevus sebaceus, first described by Jadassohn in 1895, is a term for a congenital hamartoma of the epidermis and adnexal structures typically involving the scalp and face. It presents at birth or appears in early childhood as a pink, orange to yellow waxy plaque with a granular pitted surface that is often hairless. The size and configuration can be variable. During puberty, the lesion thickens and becomes verrucous as glands enlarge within the dermis. Development of cutaneous and adenexal neoplasms has been reported in 10–20% of lesions after puberty and in adulthood. These neoplasms are most commonly benign. Surgical treatment addresses cosmetic issues, as well as prophylaxis or treatment of neoplasms.

Management strategy

For most lesions, clinical examination is sufficient to establish the diagnosis. A skin biopsy can confirm the clinical impression when indicated. Most neoplastic growths that arise in a nevus sebaceous do not develop until after the age of 16 years; the overwhelming majority of cases are benign. These include syringocystadenoma papilliferum, trichoblastoma, tricholemmoma, sebaceoma, nevocellular nevus, and seborrheic keratosis. The most common malignancy that develops within a nevus sebaceous is a basal cell carcinoma, but the absolute incidence is very rare. Isolated case reports describe rare patients who have developed sebaceous carcinoma, squamous cell carcinoma, tricholemmal carcinoma or microcystic adnexal carcinoma within nevus sebaceus.

In 2000, a case series established that trichoblastoma was the most common neoplasm arising in nevus sebaceus. With this evidence of minimal risk of malignant neoplastic transformation, prophylactic surgery is not justified. Conservative management with clinical observation and biopsy of any lesions suspicious for malignancy appears to be most prudent.

First-line therapies

imageObservation D
imageSurgical excision E

Based on recent case series and histological analyses that demonstrate the incidence of basal carcinoma is rare, particularly in children, clinical observation should be considered as the first option for any intervention. Prophylactic surgical excision is not warranted based on current data. Elective surgical excision may be considered if lesions become symptomatic or impact appearance. In instances of biopsy-confirmed neoplastic transformation, management should be dictated by the histology of the specific tumor.

Second-line therapies

imageCurettage and cautery E
imageCryotherapy E
imageLaser resurfacing E
imagePhotodynamic therapy E

A variety of destructive methods have been described for treatment of nevus sebaceus and provide an alternative to surgical excision; however, they may not be as effective in removal of deeper structures.

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Nevus sebaceus

Stuart R. Lessin and Clifford S. Perlis

Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports

image

Nevus sebaceus, first described by Jadassohn in 1895, is a term for a congenital hamartoma of the epidermis and adnexal structures typically involving the scalp and face. It presents at birth or appears in early childhood as a pink, orange to yellow waxy plaque with a granular pitted surface that is often hairless. The size and configuration can be variable. During puberty, the lesion thickens and becomes verrucous as glands enlarge within the dermis. Development of cutaneous and adenexal neoplasms has been reported in 10–20% of lesions after puberty and in adulthood. These neoplasms are most commonly benign. Surgical treatment addresses cosmetic issues, as well as prophylaxis or treatment of neoplasms.

Management strategy

For most lesions, clinical examination is sufficient to establish the diagnosis. A skin biopsy can confirm the clinical impression when indicated. Most neoplastic growths that arise in a nevus sebaceous do not develop until after the age of 16 years; the overwhelming majority of cases are benign. These include syringocystadenoma papilliferum, trichoblastoma, tricholemmoma, sebaceoma, nevocellular nevus, and seborrheic keratosis. The most common malignancy that develops within a nevus sebaceous is a basal cell carcinoma, but the absolute incidence is very rare. Isolated case reports describe rare patients who have developed sebaceous carcinoma, squamous cell carcinoma, tricholemmal carcinoma or microcystic adnexal carcinoma within nevus sebaceus.

In 2000, a case series established that trichoblastoma was the most common neoplasm arising in nevus sebaceus. With this evidence of minimal risk of malignant neoplastic transformation, prophylactic surgery is not justified. Conservative management with clinical observation and biopsy of any lesions suspicious for malignancy appears to be most prudent.

Trichoblastoma is the most common neoplasm developed in nevus sebaceus of Jadassohn: a clinicopathologic study of a series of 155 cases.
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