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| CASE REPORT |
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| Year : 2020 | Volume
: 34
| Issue : 3 | Page : 172-174 |
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Nevus sebaceous associated with basal cell carcinoma
Moirangthem Henary Singh1, L Rashil Simon2, Angelica Laiphrakpam3, L Sushila Devi1
1 Department of Pathology, JNIMS, Imphal, Manipur, India
2 Department of Surgery, JNIMS, Imphal, Manipur, India
3 Senior Resident, Department of Plastic and Reconstructive Surgery, AFMC, Pune, Maharashtra, India
| Date of Submission | 05-Jan-2021 |
| Date of Acceptance | 06-Mar-2021 |
| Date of Web Publication | 29-Apr-2021 |
Correspondence Address:
Moirangthem Henary Singh
Department of Pathology, JNIMS, Imphal 795 005, Manipur
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jms.jms_7_21
Nevus sebaceous of Jadassohn is a congenital, uncommon hamartomatous lesion of the epidermis, dermis, and appendages with the predominance of sebaceous elements. This hamartoma has the capacity to develop benign as well as malignant neoplasms, but the malignant transformation is rare. Herein, we report a case of basal cell carcinoma in the background of nevus sebaceous in a 53-year-old female highlighting the importance of prophylactic excision of this lesion.
Keywords: Basal cell carcinoma, epidermal hyperplasia, histopathological examination, nevus sebaceous
How to cite this article:
Singh MH, Simon L R, Laiphrakpam A, Devi L S. Nevus sebaceous associated with basal cell carcinoma. J Med Soc 2020;34:172-4 |
| Introduction | |  |
Nevus sebaceous is an uncommon benign congenital hamartomatous lesion having different proportions of epithelial, follicular, and apocrine malformation with the predominance of sebaceous malformations. The lesions usually appear at birth as small swelling and they can progressively begin to appear verrucous, thickened plague with irregular borders at late childhood and adulthood. Nevus sebaceous presents 0.05%–1% of outpatients attending to the dermatology clinic[1] and occurs in 0.3% of newborns.[2] The lesions have similar prevalence in both sexes, and occasionally with a positive familial history. Histologically, a nevus sebaceous is characterized by papillomatous hyperplasia of the epidermis and sebaceous glands with incompletely differentiated hair structure. Recent etiopathogenic studies point to an association with human papillomavirus or patched gene mutations.[3],[4] Both benign and malignant neoplasms can develop in nevus sebaceous during late adulthood.[3] The case is being reported for its rarity and its potential risk for the development of neoplasm.
| Case report | | |
A skin biopsy of a papillomatous verrucous lesion on the scalp of a 53-year-old woman with a history of its presence since birth as a well-circumscribed, slightly elevated hairless lesion which gradually increase in size, was sent to our department from the Department of Surgery, JNIMS, for histopathological examination. The specimens obtained were subjected to formalin fixation and paraffin embedding, stained with hematoxylin and eosin and studied. Microscopical examination revealed basal cell carcinoma (BCC) on the ground of nevus sebaceous. Sections studied from skin biopsy show papillomatosis with epidermal hyperplasia with a large number of mature-looking sebaceous glands, numerous immature hair follicles, occasional dilated hair follicles which directly open into the epidermal surface, and numerous dilated apocrine glands in the dermis [Figure 1]. | Figure 1: Microscopy showing epidermal hyperplasia, numerous sebaceous glands, and immature hair follicles (H and E, ×10)
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The dermis also shows a tumor consisting of numerous lobules and islands of basaloid cells having round to oval nuclei with basophilic cytoplasm showing numerous atypical mitotic figures [Figure 2], peripheral palisading, clefting in between tumor islands/lobules, and adjoining stroma [Figure 3]. | Figure 2: Microscopy showing lobules of tumor islands with numerous atypical mitotic figure (H and E, ×40)
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 | Figure 3: Microscopy showing lobules of basaloid cells in peripheral palisading with clefting between tumor islands and stroma (H and E, ×10)
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| Discussion | | |
Nevus sebaceous is uncommon hamartomatous lesions present in 0.3% of neonates and 0.68% of skin biopsy specimens and was first described by Jadassohn in 1895 and the most common location is head and neck, though it can occur elsewhere in the body. Lesion is usually recognized at birth or early childhood as a hairless slightly elevated small lesion, but after puberty, it may become larger and verrucous.[2]
It tends to evolve in three stages. In the first stage, the sebaceous glands in the nevus sebaceous may be underdeveloped and greatly reduced in size and number. At puberty or the second stage, large numbers of mature or nearly mature sebaceous glands and overlying papillomatous hyperplasia of the epidermis are seen showing the diagnostic histological features.[4] In the third or neoplastic stage, secondary tumor development occurs. Rapid enlargement of the development of nodularity or erosion are clinical signs suggesting neoplastic transformation. Benign tumors are the most common including trichoblastoma and syringocystadenoma papilliferum.[2],[4] Cribier et al. reported an incidence of 13.6% of benign tumors in the study.[5] Malignant transformation can occur in 2.5% of the cases and is considered rare, with BCC (1.1%), squamous cell carcinoma (0.57%), sebaceous carcinoma, and apocrine carcinoma among them. BCC is the most commonly diagnosed malignant neoplasm in the nevus sebaceous. Trichoblastoma may pause diagnostic confusion with BCC. Recent studies suggest that some of the cases previously thought to be BCC might actually be trichoblastoma; thus, the incidence of BCC might be closer to 0.8% which is rare.[3] Owing to the possibility of development of malignant tumors in a nevus sebaceous and increasing incidence with age, prophylactic excision is to be done particularly in older adults.
| Conclusion | | |
This case report highlights the neoplastic potential of nevus sebaceous and the importance of understanding the condition and early excision.
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 | | |
| 1. | Dilek N, Bedir R, Yüksel D, Ataseven A. A case of basal cell carcinoma secondary to nevus sebaceous. Int J Case Rep Image 2014;5:277-80.  |
| 2. | Gupta SK, Gupta V. Basal cell carcinoma and syringocystadenoma papilliferum arising in nevus sebaceous on face-a rare entity. Indian J Dermatol 2015;60:637. [ PUBMED] [Full text] |
| 3. | Paninson B, Trope BM, Moschini JC, Jeunon-Sousa MA, Ramos-E-Silva M. Basal cell carcinoma on a nevus sebaceous of Jadassohn: A case report. J Clin Aesthet Dermatol 2019;12:40-3. |
| 4. | Elder DE, Elenitsas R, Johnson BL, Murphy GF. Lever's Histopathology of the Skin. 11 th ed. Philaldephia: Lippincott Williams and Wilkins; 2015. |
| 5. | Cribier B, Scrivener Y, Grosshans E. Tumors arising in nevus sebaceus: A study of 596 cases. J Am Acad Dermatol 2000;42:263-8. |
[Figure 1], [Figure 2], [Figure 3]
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