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Nevus sebaceous on face: Histopathological and dermoscopic correlation


1 Department of Dermatology, Venereology and Leprosy, Pt. B. D. Sharma, PGIMS, Rohtak, Haryana, India
2 Department of Dermatology, Venereology and Leprology, Pt. B. D. Sharma, University of Health Sciences, Rohtak, Haryana, India

Date of Web Publication24-Jan-2020

Correspondence Address:
Priyadarshini Sahu,
Department of Dermatology, Venereology and Leprology, Pt B. D. Sharma, University of Health Sciences, Rohtak - 124 001, Haryana
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/idoj.IDOJ_113_19



How to cite this URL:
Sahu P, Lakra S, Dayal S. Nevus sebaceous on face: Histopathological and dermoscopic correlation. Indian Dermatol Online J [Epub ahead of print] [cited 2020 Feb 17]. Available from: http://www.idoj.in/preprintarticle.asp?id=276542



A 16-year-old boy presented with a single raised lesion over right cheek since birth, which gradually increased in size and became raised and greasy in texture since 3 years. Past and family history was noncontributory. There was no history of any other cutaneous and systemic involvement. On examination, a well-demarcated, greasy yellowish orange plaque of size 3 × 2 cm2 was present over right cheek, with follicular prominences [Figure 1]. General physical and systemic examinations were within normal limits. Differential diagnosis of nevus sebaceous and nevoid sebaceous hyperplasia was kept.
Figure 1: A well-demarcated, greasy yellowish orange plaque of size 3 × 2 cm2 present over right cheek

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On dermoscopic examination, yellowish and brownish globules on a yellowish background, perifollicular yellowish-brown globules, and linear vessels at the periphery of the lesion were seen [Figure 2]. Histopathology revealed verrucous proliferation of epidermis and dermis showed ill-developed hair follicles, mature sebaceous glands with patchy inflammation [Figure 3]. On the basis of clinical, histopathological, and dermoscopic findings, a diagnosis of nevus sebaceous was made and patient underwent removal of the lesion.
Figure 2: Dermoscopy showed yellowish (black arrow), perifollicular yellowish-brown (green arrow), and brownish (blue arrow) globules in cluster with linear vessels (green arrow), and red lacuna is the biopsy site (using DermLite 4; 3rd Gen; polarized mode, 10×)

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Figure 3: Verrucous proliferation of epidermis with follicular plugging and dermis showed rudimentary hair follicles surrounded by lobules of mature sebaceous glands with patchy inflammation around them (H and E; 40×)

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Nevus sebaceous of Jadassohn (NSJ) is a hamartomatous lesion with an epithelial and adnexal origin which is typically asymptomatic at birth. Sebaceous nevus is a benign lesion that occurs most frequently on the scalp (59.3%) but has also been found on the face (32.6%), preauricular area (3.8%), neck (3.2%), and locations off the head and neck (1.3%).[1] NSJ evolves through three stages. In the infantile stage, it presents as solitary smooth, yellow, well-circumscribed hairless plaques. At puberty, it becomes more prominent as a verrucous or mamillated appearance. The final stage is characterized by nodular or tumoral appearance with peripheral telangiectasias.[2] Trichoblastoma is the most frequently occurring tumor in NSJ, followed by syringocystadenoma papilliferum.[1]

The dermoscopic features include yellowish globules aggregated in a “cobblestone pattern,” whitish-yellow lobular aspect, yellow-grayish papillary appearance, homogenous yellowish, and peripheral vascularization (linear, irregular, or arborescent).[3] In 80% of patients, brownish globules are seen, with two type of arrangements, first “cerebriform pattern” and another characterized by crater at center with peripheral striations or extensions.[3]

Clinical, hispathological, and dermoscopic features correlation is given in [Table 1].[4] This case represents elevated plaque stage of NSJ which shows rounded structure of a yellowish-brown color on dermoscopy that corresponds to clusters of mature superficial sebaceous glands as seen in histopathology of the lesion. Thus, dermoscopy is a handy tool in differentiating various stages of NSJ especially tumoral stage. Second, it is useful in differentiating it from other sebaceous affections, i.e., sebaceous adenoma (two types of dermoscopic pattern are seen, first central crater with crown vessels and blood crust and second arborizing vessels, yellow comedone-like globules without central crater), and sebaceous hyperplasia (a central crater with crown peripheral vascularization on a yellow background).[5] Further, there are a few case reports of NSJ on face and usually are associated with scalp involvement.[6],[7] In this case, we report dermoscopic features of an isolated lesion of nevus sebaceous on face without involvement of scalp, which is quite rare. Furthermore, in our case we also found perifollicular yellowish-brown globules, which may be secondary to follicular plugging. To the best of our knowledge, these perifollicular yellowish-brown globules are not yet reported.
Table 1: Clinical, histopathological and dermoscopic correlation in Nevus sebaceous[4]

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As there is a risk of developing secondary benign or malignant neoplastic changes in NSJ, so careful monitoring is required for its early detection and dermoscopy is a useful tool for this monitoring without invasive procedure like biopsy. The treatment of NSJ includes surgical excision, CO2 laser, photodynamic therapy, cryotherapy, and electrosurgery.[2]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Eisen DB, Michael DJ. Sebaceous lesions and their associated syndromes: Part I. J Am Acad Dermatol 2009;61:549-60.  Back to cited text no. 1
    
2.
Srivastava D, Taylor RS. Appendage tumours and hamartomas of the skin. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, editors. Fitzpatrick's Dermatology in General Medicine. 8th ed. New York: McGraw-Hill Companies, Inc; 2012. p. 1375-6.  Back to cited text no. 2
    
3.
Ankad BS, Beergouder SL, Domble V. Trichoscopy: The best auxiliary tool in the evaluation of nevus sebaceous. Int J Trichol 2016;8:5-10.  Back to cited text no. 3
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4.
Kelati A, Baybay H, Gallouj S, Mernissi FZ. Dermoscopic analysis of nevus sebaceus of Jadassohn: A study of 13 cases. Skin Appendage Disord 2017;3:83-91.  Back to cited text no. 4
    
5.
Marques-da-Costa J, Campos-do-Carmo G, Ormiga P, Ishida C, Cuzzi T, Ramos-E-Silva M. Sebaceous adenoma: Clinics, dermatoscopy, and histopathology. Int J dermatol 2015;54:200-2.  Back to cited text no. 5
    
6.
Baliga V, Gopinath VP, Baliga S, Chandra U. Oral findings in a patient with Sebaceous Nevi - A Case Report. J Int Oral Health 2013;5:139-42.  Back to cited text no. 6
    
7.
Chi SG, Kim JY, Kim HY, Lee SJ, Kim DW, Lee WJ. Multiple nevus sebaceous occurring on scalp and on contralateral side of the face. Ann Dermatol 2011;23:389-91.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

 
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