The development of malignant tumors in nevus sebaceOus - Therapeutic consequences

Objective: Nevus sebaceus has been considered a relatively infrequent and u nimportant congenital hamartoma for plastic surgeons, unless the lesions ar e so big that they require a large closure of the defect. As such tumors ar e primarily of a benign nature and the malformed sebaceus glands are locate d abnormally high in the dermis, surgeons are tempted not to excise the tum ors but to eradicate them by dermabrasion or laser beam therapy. Yet, a nev us sebaceus does not only affect sebaceus glands but includes various other malformations of the affected skin and its appendages. In addition, differ ent malignant tumors may occur in nevus sebaceus, even in children and youn g adults. Materials and methods: We encountered 4 such malignant tumors out of 18 nev us sebaceus operated from 1989 to 1997. All nevi had been clinically incons picuous. Results: In three patients, one of them being only fifteen years old, an as sociated basal cell carcinoma was found. The fourth patient had a mixture o f three additional tumors, a cystadenoma, a keratoacanthoma and a basal cel l carcinoma besides the sebaceous malformations. Conclusion: These findings have two consequences. The first is to continue surgical treatment of nevus sebaceus instead of dermabrasion or dermablatio n and to have the specimen examined histologically. The second consequence is to excise such tumors as early as possible.