Nevus Sebaceus Treatment & Management

  • Author: Anwar Al Hammadi, MD, FRCPC; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jun 9, 2010
 

Medical Care

Photodynamic therapy with topical aminolevulinic acid has been reported to have a good response for a nonsurgical ablative treatment in a limited number of cases.

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Surgical Care

The risk of malignancy is difficult to establish with precision, and malignant change may occur at any age. Because of this risk, many authorities recommend complete surgical excision, preferably before puberty, because the lesion thickens and the risk of malignancy increases with age.

Full-thickness skin excision is usually required, and topical destruction is not recommended because it may mask malignant changes underneath the surface. Primary reconstruction is usually possible.

The timing of excision remains a matter of debate. Nevus sebaceus often is treated with observation until puberty because malignant degeneration is rare before this time. However, many factors need to be considered, including the size and the location of the nevus sebaceus, its cosmetic significance, and the risk-to-benefit ratio of general anesthesia, which is usually needed when the surgery is performed early in life, versus local anesthesia for surgery later in childhood or adolescence.[11]

A 2007 study by Barkham et al concluded that prophylactic excision of all sebaceous nevi is not warranted, particularly in young children, and excision should be only recommended when benign or malignant neoplasms are clinically suspected or for cosmetic reasons.[12]

Carbon dioxide lasers have been used to treat a patient with involvement of the nose; however, the long-term risk of developing malignant transformation in any remaining deep dermal component must be considered.

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Consultations

Patients should be examined for other associated findings as part of the linear nevus sebaceus syndrome. Pediatricians and other primary care providers working with the parents are usually the first to suspect or recognize neurologic or orthopedic abnormalities and to refer to the appropriate specialists. Consult a neurologist for epilepsy and other neurologic defects. Consult an orthopedist for skeletal deformities.

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Contributor Information and Disclosures
Author

Anwar Al Hammadi, MD, FRCPC  Consultant and Head of Dermatology, Rashid Hospital, Dubai Health Authority; Clinical Assistant Professor of Dermatology, University of Sharjah, United Arab Emirates

Anwar Al Hammadi, MD, FRCPC is a member of the following medical societies: American Academy of Dermatology, Canadian Dermatology Association, Royal College of Physicians and Surgeons of Canada, and Skin Cancer Foundation

Disclosure: Nothing to disclose.

Coauthor(s)

Mark G Lebwohl, MD  Chairman, Department of Dermatology, Mount Sinai School of Medicine

Mark G Lebwohl, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Abbott Laboratories Honoraria Consulting; Amgen/Pfizer Honoraria Consulting; Astellas Honoraria Consulting; Centocor/Janssen Honoraria Consulting; DermiPsor Honoraria Consulting; GlaxoSmithKline Honoraria Consulting; Graceway Consulting; HelixBioMedix Honoraria Consulting; LEO Honoraria Consulting; Novartis Honoraria Consulting

Specialty Editor Board

Daniel Mark Siegel, MD, MS  Director, Procedural Dermatology Fellowship Program, Clinical Professor of Dermatology, Department of Dermatology, State University of New York Downstate

Daniel Mark Siegel, MD, MS is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American College of Physician Executives, American Society for Dermatologic Surgery, American Society for MOHS Surgery, and International Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Van Perry, MD  Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas Health Science Center

Van Perry, MD is a member of the following medical societies: American Academy of Dermatology and American Society for Laser Medicine and Surgery

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Jaqueti G, Requena L, Sanchez Yus E. Trichoblastoma is the most common neoplasm developed in nevus sebaceus of Jadassohn: a clinicopathologic study of a series of 155 cases. Am J Dermatopathol. Apr 2000;22(2):108-18. [Medline].

  2. Warnke PH, Russo PA, Schimmelpenning GW, et al. Linear intraoral lesions in the sebaceous nevus syndrome. J Am Acad Dermatol. Feb 2005;52(2 Suppl 1):62-4. [Medline].

  3. Kavak A, Ozcelik D, Belenli O, Buyukbabani N, Saglam I, Lazova R. A unique location of naevus sebaceus: labia minora. J Eur Acad Dermatol Venereol. Sep 2008;22(9):1136-8. [Medline].

  4. Baykal C, Buyukbabani N, Yazganoglu KD, Saglik E. [Tumors associated with nevus sebaceous]. J Dtsch Dermatol Ges. Jan 2006;4(1):28-31. [Medline].

  5. Cribier B, Scrivener Y, Grosshans E. Tumors arising in nevus sebaceus: A study of 596 cases. J Am Acad Dermatol. Feb 2000;42(2 Pt 1):263-8. [Medline].

  6. Correale D, Ringpfeil F, Rogers M. Large, papillomatous, pedunculated nevus sebaceus: a new phenotype. Pediatr Dermatol. May-Jun 2008;25(3):355-8. [Medline].

  7. Ivker R, Resnick SD, Skidmore RA. Hypophosphatemic vitamin D-resistant rickets, precocious puberty, and the epidermal nevus syndrome. Arch Dermatol. Dec 1997;133(12):1557-61. [Medline].

  8. Fearfield LA, Bunker CB. Familial naevus sebaceous of Jadassohn. Br J Dermatol. Dec 1998;139(6):1119-20. [Medline].

  9. Happle R, Konig A. Familial naevus sebaceus may be explained by paradominant transmission. Br J Dermatol. Aug 1999;141(2):377. [Medline].

  10. Sahl WJ Jr. Familial nevus sebaceus of Jadassohn: occurrence in three generations. J Am Acad Dermatol. May 1990;22(5 Pt 1):853-4. [Medline].

  11. Paller A, Mancini A, eds. Tumors of epidermal appendages. In: Hurwitz Clinical Pediatric Dermatology. 3rd ed. Philadelphia, Pa: Elsevier Saunders; 2006:221-2.

  12. Barkham MC, White N, Brundler MA, Richard B, Moss C. Should naevus sebaceus be excised prophylactically? A clinical audit. J Plast Reconstr Aesthet Surg. 2007;60(11):1269-70. [Medline].

  13. Beer GM, Widder W, Cierpka KA, Kompatscher P, Meyer VE. [The development of malignant tumors in nevus sebaceus--therapeutic consequences]. Wien Klin Wochenschr. Mar 26 1999;111(6):236-9. [Medline].

  14. Elghamriny MS. Tumors with sebaceus gland differentiation. In: Ghamriny's Clinical Dermatology. Vol 2. 2000:658-59.

  15. Hamilton KS, Johnson S, Smoller BR. The role of androgen receptors in the clinical course of nevus sebaceus of Jadassohn. Mod Pathol. Jun 2001;14(6):539-42. [Medline].

  16. Happle R. Loss of heterozygosity in human skin. J Am Acad Dermatol. Aug 1999;41(2 Pt 1):143-64. [Medline].

  17. Happle R. Mosaicism in human skin. Understanding the patterns and mechanisms. Arch Dermatol. Nov 1993;129(11):1460-70. [Medline].

  18. Ho VC, Freedberg IM, Eisen AZ, Wolff K. Benign epithelial tumors (nevus sebaceus). In: Fitzpatrick's Dermatology In General Medicine. Vol 1. New York, NY: McGraw-Hill; 1999:878-79.

  19. Lupton JR, Elgart ML, Sulica VI. Segmental neurofibromatosis in association with nevus sebaceus of Jadassohn. J Am Acad Dermatol. Nov 2000;43(5 Pt 2):895-7. [Medline].

  20. McKee PH. Naevi and tumors of sebaceus gland derivation. In: Essential Skin Pathology. St. Louis: Mo: Mosby; 1999:169-70.

  21. Moody BR, Hurt MA. Surgical management of the cutaneous manifestations of linear nevus sebaceus syndrome. Plast Reconstr Surg. Feb 2004;113(2):799-800. [Medline].

  22. Odom RB, James WD, Berger TG. Sebaceus nevi and tumors. In: Andrews' Diseases of the Skin. 9th ed. Philadelphia, Pa: WB Saunders; 2000:845-46.

 
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Nevus sebaceus in a 4-month-old baby manifesting as nodular plaque.
Brownish wartlike plaque in a 25-year-old patient.
Nevus sebaceus manifesting as a bald patch in a child.
Nevus sebaceus manifesting as an orange-yellow plaque with a smooth or somewhat velvety surface in a 6-month-old baby.
Nevus sebaceus manifesting as a small plaque beside a scaly scalp in a 13-year-old boy.
Linear type of nevus sebaceus.
Mild papillomatosis of the epidermis with sebaceus gland lobules opening directly onto the epidermis.
Mild papillomatosis at high power.
 
 
 
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