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. A case series has suggested that topical sirolimus can possibly be used in the treatment of nevus sebaceus, particularly in patients who decline surgical treatment. [14]
Surgical Care
The risk of malignancy is low and almost always occurs after puberty. Unless stigmatization, disfigurement, symptomatology, or a growing tumor within the lesion is present, excision is delayed until adulthood when the patient may participate in the decision. [15]
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.
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 recommended only when benign or malignant neoplasms are clinically suspected or for cosmetic reasons. [16]
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, the authors believed it is reasonable to delay surgical management until adolescence. [17]
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.
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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Nevus sebaceus in a 4-month-old baby manifesting as nodular plaque.
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Brownish wartlike plaque in a 25-year-old patient.
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Nevus sebaceus manifesting as a bald patch in a child.
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Nevus sebaceus manifesting as an orange-yellow plaque with a smooth or somewhat velvety surface in a 6-month-old baby.
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Nevus sebaceus manifesting as a small plaque beside a scaly scalp in a 13-year-old boy.
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Linear type of nevus sebaceus.
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Mild papillomatosis of the epidermis with sebaceus gland lobules opening directly onto the epidermis.
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Mild papillomatosis at high power.
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Verrucous plaque in a 19-year-old woman.
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Verrucous plaque in a 12-year-old-girl.
