Surgical management of the cutaneous manifestations of linear nevus sebaceus syndrome

Trichilemmoma Arising in a Sebaceous Nevus Successfully Treated with Cryotherapy

Nevus sebaceous of Jadassohn (NSJ) is a benign congenital hamartoma composed of follicular, adnexal appendages and epidermal hyperplasia. Various secondary neoplasms, mostly adnexal in origin, can arise within nevus sebaceous. We report the case of a 16-year-old female who had NSJ associated with trichilemmoma, which was successfully treated with cryotherapy. We found cryotherapy to be an effective, satisfactory therapy, with acceptable cosmetic results, especially for patients who have visible lesions that can be easily followed.

Schimmelpenning Syndrome: An Association with Vascular Anomalies

Objective:

Schimmelpenning syndrome is a rare neurocutaneous disorder characterized by craniofacial nevus sebaceus in association with seizures, developmental delay, and ocular or skeletal pathology. Vascular anomalies also have been described in this condition, and some authors have suggested that the two entities are associated. The purpose of this study was to determine the prevalence of vascular anomalies in Schimmelpenning syndrome.

Methods:

We reviewed the medical records of patients with Schimmelpenning syndrome who were evaluated or were managed at Children's Hospital Boston between 1980 and 2005. In addition, all published cases purported to be Schimmelpenning syndrome were analyzed to determine whether the primary diagnosis was accurate and whether or not there were concurrent vascular anomalies.

Results:

Three of nine patients (33.3%) in our series had a vascular malformation. One patient had coarctation, aortic aneurysm, renal artery, and carotid stenosis; another had a thoracic lymphatic anomaly with chylothorax; and the third had lymphedema of the lower extremities and lymphatic malformation of the neck/chest with chylothorax. Additional findings were seizures (78%), ocular pathology (78%), developmental delay (56%), and skeletal abnormalities (67%). Of 119 cases of authenticated Schimmelpenning syndrome in the literature, 18 vascular malformations were documented in 15 patients (12.6%): venous (n = 7); arterial (n = 5); lymphatic (n = 3); capillary (n = 2); and arteriovenous (n = 1).

Conclusions:

Vascular malformations occur with a higher frequency (12.6 to 33%) in patients with Schimmelpenning syndrome compared with the general population (<1%). Therefore, we conclude that there is an association between vascular anomalies and Schimmelpenning syndrome.

Somatic KRAS mutation in an infant with linear nevus sebaceous syndrome associated with lymphatic malformations: A case report and literature review

RATIONALE

Linear nevus sebaceous syndrome (LNSS) is a rare neurocutaneous syndrome, characterized by nevus sebaceous,central nervous system (CNS), ocular and skeletal abnormalities. The present study describes KRAS somatic mosaic mutation in a case of LNSS with lymphatic malformations (LMs).

PATIENT CONCERNS

A 4-month-old female with a clinical diagnosis of LNSS presented with infantile spasms, mental retardation, skull dysplasia, ocular abnormalities, congenital atrial septal defect, and LMs.

DIAGNOSIS

Cervical ultrasonography revealed a 4.6 × 4.6 × 2.2cm no echo packet with clear boundary in the subcutaneous tissues of the right neck. The neck MRI indicated a cyst in the subcutaneous tissues of the right neck. Whole-exome sequencing revealed a low-level heterozygous mutation of the KRAS gene (c.35C > T; p.G12D, 19%) in the skin lesion sample. This mutation was not present in the blood samples of the patient and her parents.

INTERVENTIONS

The patient received sclerotherapy with paicibanil (OK-432) injection for the cyst.

OUTCOMES

Following 1 year of treatment, the patient exhibited fewer seizures. The mental and motor development was significantly improved. The patient can currently walk with assistance and speak simple words.

LESSONS

LNSS is a rare, congenital neurocutaneous syndrome consisting of a spectrum of abnormalities involving the skin, central nervous system, eyes, LMs and other systems. LNSS can be caused by postzygotic somatic mutation in the RAS family of genes. Multidisciplinary evaluation and treatment is needed.

Postauricular cerebriform sebaceous nevus: case report and literature review

Epidermal nevi are abnormal collections of cells derived from the embryonic epidermis. They are believed to represent cutaneous genetic mosaicism, with the histopathologic appearance related to mutations in genes involved in epidermal growth and differentiation. The clinical phenotype and potential inheritance are also related to these mutations and the time during embryogenesis when a mutation occurs. Since mutation timing in development is variable and the alleles are numerous, nevi have wide clinical variation. The lesions can be solitary, occur diffusely, or arise in association with other organ system abnormalities. Sebaceous nevus is a common subtype of epidermal nevi in which sebaceous gland-like structures predominate microscopically. Most lesions are alopecic, flat or slightly raised, and appear on the face and scalp. We review the presentation and treatment of a patient with an unusual appearing postauricular sebaceous nevus that was raised in a cerebriform appearing fashion, and discuss the related literature.

Linear nevus sebaceous syndrome associated with choroidal hemangioma

PURPOSE

To report a rare case of linear nevus sebaceous syndrome in a little Chinese girl with a new ocular finding.

METHODS

Case report. The clinical manifestations, ophthalmic features and central nervous system abnormalities associated with this neurocutaneous syndrome are presented.

RESULTS

A little girl, aged 1 year and 8 months, had several linear or oval nevi on her forehead and parietal scalp. Three round well-defined subcutaneous masses, approximately 1 cm in size, were present on the occipital, parietofrontal and right mastoid region, respectively. A round choroidal hemangioma, approximately 4-5 PD in diameter, was found in the superotemporal portion of the right fundus without retinal detachment. A round mass, 8 x 8 mm in size and tough in consistency, was located in the left upper eyelid, together with a 1/2 coloboma of the middle upper eyelid. Extensive choristomas of the superior bulbar conjunctiva and nearly the whole cornea were found in the left eye. CT-scans of both the brain and orbit disclosed left cerebral hypoplasia, dysplasia of sphenoid bone and temporal bone, and multiple calcifications of posterior sclera of both the right and the left eye. The mass on the left upper eyelid was removed and pathological examination confirmed the diagnosis of eyelid choristoma.

CONCLUSIONS

Patients with linear nevus sebaceous syndrome may have choroidal hemangioma.

Nevus Sebaceus of Jadassohn

The nevus sebaceus of Jadassohn (SNJ) is a hamartomatous disorder of the skin and its adnexa pertaining to the group of "organoid nevi,'' most frequently involving the face and scalp. During adulthood, patients with SNJ have a 10% to 20% risk of the development of cutaneous or adnexal neoplasia, so that prophylactic excision before puberty is recommended by most authors, and tissue expansion is considered to be the best method of reconstruction. It has been largely demonstrated in literature that most of the lesions that have been interpreted as basal cell carcinoma (BCC) are actually examples of primitive follicular induction or trichoblastomas, not authentic BCCs. A literature review on histopathologic findings associated with SNJ and a retrospective chart review of two cases occurring in young females are presented. In one case, the lesion was treated by intraoperative expander-assisted reduction and scalp graft (Case 1); in the other one, a primary closure with adjacent tissue was performed (Case 2). No signs of malignant degeneration or residual pathology have been found. For treatment of the biggest lesions, when preoperative tissue expansion cannot be performed, intraoperative one, transfer of a scalp graft has been shown to be a good reconstructive method. For the smallest lesions, a primary closure with adjacent tissue is sufficient.