Optimal Timing for Surgical Excision of Nevus Sebaceus on the Scalp: A Single-Center Experience

Abstract

BACKGROUND Treatment of nevus sebaceus (NS) on the scalp is usually surgical excision, but the optimal timing is debatable. The scalp presents significant challenges to the reconstructive surgeon because the lack of elasticity of the scalp makes the repair of defects difficult. OBJECTIVE The aim of this study was to investigate the optimal timing for surgical excision of NS on the scalp through postoperative outcomes. METHODS The authors retrospectively reviewed the postoperative cosmetic results of patients with a follow-up period of 12 to 15 months. The variables analyzed were patient demographics, preoperative tumor size, location, operative time, cosmetic results, and complications. RESULTS This study enrolled 62 patients, including 30 adults and 32 children. The main complications were hair loss, hypertrophic scar, and widening of the scar. The overall complication rate was 17.7%, and the complication rate in children (9/32, 28.1%) was higher than that in adults (2/30, 6.7%) (p < .05). Tumor location, shape, and size showed no association with complications. CONCLUSION Complications after surgical excision of NS on the scalp are more likely to occur in children than in adults. On the basis of these findings, surgical excision of NS on the scalp can be delayed until after childhood.

Rate of Benign and Malignant Secondary Tumors Associated With Nevus Sebaceous

“…First, earlier studies may have misdiagnosed basaloid proliferations as BCC. Ackerman et al 94 suggested that benign tumors originating from follicular germinative cells with well-circumscribed symmetrical structure can mimic BCC but are trichoblastomas. This is supported by multiple later studies 7,11,79 .…”

“…Kong et al 94 retrospectively reviewed the cosmetic outcomes of NS resection in adults and children; complications including alopecia and hypertrophic or stretched scars were more common in the pediatric group (<18 years of age; 28.1%) when compared with the included adult patients (6.7%). However, these findings were drawn from single institution, with a limited sample totaling only 62 patients.…”

“…However, these findings were drawn from single institution, with a limited sample totaling only 62 patients. Furthermore, the included children demonstrated larger initial tumor sizes than the adults, and the length of follow-up of all patients was somewhat limited 94 …”

“…Furthermore, the included children demonstrated larger initial tumor sizes than the adults, and the length of follow-up of all patients was somewhat limited. 94 Recently, specific inhibitors of the RAS/MAPk or PIK3-AKT-mTOR pathways such as sirolimus and alpelisib have shown efficacy but are not in routine clinical use and would require biopsy for mutation analysis to confirm drug susceptibility. 95,96 Recommendations Unless contraindicated, we perform early prophylactic excision.…”