In most cases, simple excision of the tumor was performed, sometimes followed by skin graft, if needed. Reported alternative treatments to surgical excision included radiotherapy, cryotherapy, and CO 2 laser ablation. However, the main disadvantage of these options is the impossibility to perform the histopathological study of the lesion.In our patient, local flaps were considered contra indicated because all the surrounding tissue was a PWS, thus the local vascular impairment could jeopardize flap survival. However, there is a lack of data on complications of local flap surgery within PWS. Direct skin grafting on the galeal tissue would have resulted in an aesthetically unpleasant bald depression. Therefore, we decided to place an ADM to improve the granulation process and achieve a satisfying aesthetic outcome.SWS and non-syndromic PWS are caused by the same GNAQ activating mutation. However, its oncogenic potential, GNAQ mutation has not been associated with increased incidence of BCC yet. 5 Although PWS is a congenital benign vascular disorder, malignant skin tumors may present within the affected area.Skin tumors at the initial stages may be difficult to be detected within the PWS, because, with the advancing age, the stain gradually darkens and the skin surface becomes thicker, raised, and nodular, concealing potential malignant lesions. 1 However, if such tumors are undiagnosed at initial stages, they may necessitate complex surgical interventions. Hence, we believe it of critical importance to encourage colleagues to perform a periodic, careful physical examination and, eventually, biopsies in areas of persistent scaling within the PWS. A continuous dermatologic follow-up should be strongly recommended especially in patients previously treated with carcinogenic agents or with chronic exposure to sunlight.
