Nevus Sebaceous

Background

• Nevus sebaceous is a common, cutaneous hamartoma presenting at birth or early childhood as a hairless, yellowish-orange plaque on the head or neck.
• Lesions may thicken and become verrucous at the onset of puberty.
• There are several associated conditions with nevus sebaceous.
• Nevus sebaceous is not linked to the human papillomavirus (HPV) and is due to a mutation in oncogenes.
• Secondary tumors develop in 25% of lesions which are usually benign.

Evaluation

• The lesion usually presents as a single lesion, but multiple lesions have been reported.
• Children with nevus sebaceous are most commonly otherwise healthy unless it is a feature of a syndrome, so perform a complete history and a thorough physical examination.
• Make the diagnosis of a nevus sebaceous based on the clinical characteristics.
• Consider a biopsy to confirm the diagnosis if uncertain.

Management

• Manage nevus sebaceous with close monitoring for most lesions.
• Consider surveillance biopsy of new growths or nodules within a nevus sebaceous to screen for atypical or malignant tumors.
• Consider prophylactic surgical excision of a nevus sebaceous if there is a concern about malignancy or undesirable cosmesis.
• Consider nonsurgical treatment with photodynamic therapy, fractional laser resurfacing, or dermabrasion for cosmesis but the risk of malignancy remains.