Coexisting Basal Cell Carcinoma and Squamous Cell Carcinoma in Congenital Nevus Sebaceous

Abstract

Nevus sebaceous (NS) is a congenital epidermal hamartoma that is present in less than 1% of newborns.1 NS appears classically on the face or scalp as a waxy, yellow-or orange-colored linear or round plaque. Lesions can involve the epidermis, hair follicle, sebaceous glands, and apocrine glands. NS frequently increases in size during puberty.2 As patients age, there is an increasing risk for the development of cutaneous neoplasms within NS. 3 The vast majority of NS-associated neoplasms are benign. Malignant neoplasms, most notably basal cell carcinoma (BCC), represent less than 1% of the cutaneous neoplasms arising from NS, and frequently affect those over the age of twenty. 3,4 We report the fourth case to our knowledge of BCC and SCC arising concurrently in the same NS.A 56-year-old Hispanic female with no significant medical history presented to clinic regarding a lesion on her left cheek (Figure 1). The lesion had been present since birth but had begun to grow over the last several months. The patient also noted mild discomfort at the site of the lesion beginning around the same time that the lesion started to grow. Family history was negative for any skin cancers or other malignancies.On examination there was a well-defined 1.4-cm x 0.8-cm pink, translucent, pearly ovoid plaque with arborizing telangiectasias overlying the mandible on the left cheek. Two biopsies were taken from the lesion edges and were sent for pathological examination. The first biopsy specimen ABSTRACTNevus sebaceous is a congenital epidermal hamartoma characterized by hyperplastic changes to the epidermis and adnexa. Nevus sebaceous is associated with an elevated risk of cutaneous neoplasms, most often benign; however, malignant neoplasms, most notably basal cell carcinoma, can also present in these patients. Although a rare occurrence more often affecting adult patients, squamous cell carcinomas have also been reported to arise at the site of pre-existing nevus sebaceous. Herein we report a unique case of a patient with basal cell carcinoma and squamous cell carcinoma arising concurrently in the same nevus sebaceous.