Nevus sebaceous has been considered a relatively infrequent and unimportant
congenital hamartoma for plastic surgeons unless the lesions are so big th
at they require a demanding defect closure. As the dignity of such tumors i
s primarily benign and the malformed sebaceous glands are localized abnorma
lly high in the dermis, the temptation is appealing not to excise these tum
ors any more but to eradicate them by laser beam therapy. Yet a nevus sebac
eous not only affects sebaceous glands but includes various other malformat
ions of the affected skin and its appendages. In addition, different malign
ant tumors may occur in nevus sebaceous. even in children and young adults.
We encountered 4 such malignant tumors of 18 nevi sebaceous operated on fr
om 1989 to 1997. All nevi had been unsuspicious macroscopically. In three p
atients, one of them only 15 years old, an associated basal cell carcinoma
was found. In the fourth patient there was a mixture of three additional tu
mors, a cystadenoma, a keratoacanthoma, and a basal cell carcinoma, besides
the sebaceous malformations. These findings have two consequences: first,
to continue surgical treatment of nevus sebaceous instead of dermabrasion o
r dermablation and to have the specimen examined histologically and, second
, to excise such tumors as early in childhood as possible.