Nevus Sebaceus Treatment & Management

Updated: Jul 18, 2017
  • Author: Anwar Al Hammadi, MD, FRCPC; Chief Editor: William D James, MD  more...
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Treatment

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. [12]

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. [13]

A 2014 retrospective analysis of 707 cases of nevus sebaceus diagnosed at the Ackerman Academy of Dermatopathology from 1999 to 2012 confirmed that most of the secondary neoplasms arising in association with nevus sebaceus are benign. Since no malignant tumors were seen in children, authors believed it is reasonable to delay surgical management until adolescence. [14]

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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Complications

Rapid, circumscribed enlargement, ulceration, or development of an exophytic nodule should raise suspicion of malignant transformation, although the development of benign appendageal tumors is considerably more common.

The most common malignancy is basal cell carcinoma, but the incidence of this tumor has been overestimated because of misinterpretation of areas of basaloid proliferation as true basal cell carcinoma. Other malignant tumors reported include eccrine, squamous, sebaceous, and apocrine carcinomas.

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