Sebaceous Nevus of the Scalp

Facial Soft Tissue Lesions in Children

Facial soft tissue lesions in children are often classified based on their structure or cellular origin and can be benign or malignant. This review focuses on common facial soft tissue lesions in children, their clinical morphology, natural history, and medical and surgical management, with an emphasis on those considerations unique to soft tissue lesions present at this anatomic site.

Application of vertical transposition flap in closure for large facial soft tissue defects in children

Background

While transposition flap is widely used for the repairs of facial defects, few studies has reported its application among children with large defects. In this study, we aimed to investigate the surgical techniques and principles in different locations on face of vertical transposition flap in children.

Methods

We retrospectively reviewed our hospital database and identified children who were treated with vertical transposition flap for large facial defects between January 2014 and December 2021. Information was collected including patients' demographics, location and dimension of the lesion, surgical procedure, additional surgeries, complications, and outcomes.

Results

A total of 122 patients (77 boys, 63.1%) were included in this study. The average age for participants was 3.3 years (3 months to 9 years). One hundred and four (85.3%) patients had melanin nevus and 18 (14.8%) had sebaceous nevus. The average size of defects was 5.8 cm² (ranging from 0.8-16.5 cm²). Ten patients (8.2%) suffered from dermal layer or full-thickness necrosis in the distal part of their flaps, They all recovered after conservative treatment and there were noticeable scars at discharge. Five patients (4.1%) had slight traction of the mouth and eyelid, all recovered about 2 week after surgery. An acceptable cosmetic outcome was achieved for all the patients at last time follow-up.

Conclusions

Repairing large facial defects with vertical transposition flap is effective in Children, especially on forehead, cheek and mandible. However, this technique is far from perfect. Careful selection of appropriate patients and flap design might be needed.

A Review on Lumps, Bumps, and Birthmarks: When and Why to Refer

Skin lesions of the face, trunk, and extremities are commonly seen in the pediatric population. Although most of these lesions are benign, they can be locally destructive or interfere with normal development. Recognition and diagnosis of these lesions allow for timely workup and referral; treatment, if needed; and facilitation of parental discussions. The purpose of this article is to review common pediatric skin and soft-tissue lesions-or "lumps, bumps, and birthmarks"-to assist with diagnosis, workup, and guidelines for referral to pediatric plastic surgery. [Pediatr Ann. 2023;52(1):e23-e30.].

Atypical Nevus Sebaceus at an Unusual Location Treated with Carbon Dioxide Laser: A Case Report

Nevus sebaceus (NS) or organoid nevus is an epidermal nevus comprising predominantly sebaceous glands with a prevalence of approximately 0.3% of the newborns. The initial clinical manifestations of NS are single or less commonly multiple yellowish patches with overlying alopecia, usually confined to the scalp. However, it can also appear on the face, preauricular area, and the neck. During puberty, skin lesions will turn into round or linear verrucous plaques accompanied with an increase in number due to the influence of androgens. As they progress, about 20% of the NS cases might turn into secondary tumors which can be benign or malignant (in 2.5% cases). NS can manifest as atypical lesions and may also arise on areas other than its predilection sites. A case of a lesion presented on an atypical location of an 18-year-old male patient treated with carbon dioxide (CO₂) laser was reported. Physical examination revealed skin-colored and blackish-brown papules arranged in groups on the left side of the patient's chest. Histopathological examination on a sample taken from one of the skin lesions on the chest showed hyperkeratosis, acanthosis, papillomatosis, and sebaceous hyperplasia, confirming the diagnosis of NS. The patient was treated with CO₂ laser, and clinical improvements were observed. Histopathological examination of NS is not routinely performed; however, it should be carried out when the lesion is atypical and presented at an unusual location, or there is a suspicion of malignancy.

Neurofibroma Within a Nevus Sebaceus: A Case Report

Nevus sebaceus most commonly presents as a yellow, alopecic plaque on the head or neck in childhood and evolves into a verrucous plaque at puberty. Numerous secondary tumors may arise within nevus sebaceus lesions. Tumors of mesenchymal origin have been rarely documented. We present a unique case of a patient who presented with a nevus sebaceus on the scalp. Excision of the tumor and subsequent histopathology of the lesion revealed a nevus sebaceus with a desmoplastic trichilemmoma, a tumor of follicular infundibulum, and a neurofibroma. This case highlights a rare finding of a mesenchymal tumor, and the first reported neurofibroma, arising in association with a nevus sebaceus.

New Donor Excision Design for Better Hair Alignment in Hair Restoration Surgery

BACKGROUND

The linear scar and misalignment of hair follicles are disadvantages of the follicular unit transplantation (FUT) or strip technique. The most common misalignment is at the end of the strip. Although most surgeons try to match hair direction to achieve optimal hair alignment, their attempts are often unsuccessful.

OBJECTIVES

We aimed to assess strip designs to improve hair alignment during hair transplantation.

METHODS

We conducted a retrospective study of 157 patients who underwent hair transplantation with either the commonly used elliptical incision or our novel triangular flag-shaped designed incision on the donor strip tip. Two blind evaluators assessed the outcome of hair alignment using a 5-point visual analog scale.

RESULTS

In total, 303 wounds on 157 patients were assessed. Overall, our triangular flag-shaped design (TFD) achieved better hair alignment than the common elliptical design (CED) (p=0.01). Patients with hair direction straight on the upper wound edge and hair direction inward on the lower wound edge showed improved outcomes with TFD, whereas patients with hair direction inward on both upper and lower wound edges showed better outcomes with CED.

CONCLUSIONS

The TFD tip of donor strips achieved proper hair alignment for most hair transplant patients.

LEVEL OF EVIDENCE IV

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Ultrasound Imaging of Nevus Sebaceous of Jadassohn

Nevus sebaceous of Jadassohn (NSJ) is a cutaneous hamartoma commonly found in the scalp and face and more frequent in children. Clinically, it presents as a yellowish and hairless plaque. In later stages, the NSJ can develop secondary tumors, including skin cancer. We reviewed the ultrasound characteristics of 9 patients (67% female; mean age, 3 years) with NSJ at 18 and 70 MHz. The ultrasound analysis covers the data on the location, thickness, echo structure, and vascularity. The provision of the ultrasound patterns of NSJ can support early diagnosis, avoid unnecessary biopsies, and support monitoring.

Treatment of the nevus sebaceous of Jadasson by a copper vapor laser

Introduction. Nevus sebaceous of Jadassohn (synonym: nevus of the sebaceous glands) (NSG) presents the congenital malformation of the skin with possible transformation into benign or malignant tumors during the adolescence or adulthood. Commonly appeared on the scalp or neck NSG is frequently concern with cosmetic problems making patients look for opportunities for its removal. Surgical removal of the NSG is related to an elevated risk of scarring. Using ablative lasers has proven to be effective in the removal of small NSG. However, the removal of medium and large NSG with ablative lasers was reported to be linked with a high risk of scarring and recurrence. The removal of the medium-sized NSG with a copper vapor laser (CVL) is described here for the first time. Case report and procedure. Laser removal of NSG (linear sized of 27 mm) was performed in a 25-year-old female patient with Fitzpatrick skin type II during eight CVL treatments. Laser settings were selected as follows: the average power of 1 W at the power ratio of 3:2 radiation at a wavelength of 511 and 578 nm. Pulse duration 20 nanoseconds, reprate 16.6 kHz, exposure duration 200 ms, and the light spot's diameter on the skin 1 mm. Results. After 8 procedures, the skin in the area of the removed NSG acquired a natural color and appearance. During 24 months of follow-up, there was no hyperpigmentation or signs of scars in the irradiated area. No relapses were observed for 24 months after the CVL removal of NSG. Conclusion. The application of non-ablative CVL removal of NSG ensured a desired cosmetic result without side effects.