Nevus Sebaceus: To Excise or Not to Excise?

January 16, 2014

Nevus Sebaceus: To Excise or Not to Excise?

  1. Mary Wu Chang, MD

Delaying surgery until adolescence is optimal.

  1. Mary Wu Chang, MD

Nevus sebaceus (NS) is a common hamartomatous birthmark found in up to 1% of dermatology patients. NS is usually noted on the head and neck region at birth and is usually stable until puberty, when it typically becomes more yellowish and cerebriform. Secondary tumors can develop within NS. The risk for malignancy is controversial, as is the timing of excision, with some advocating early excision while others recommend delayed excision or none at all. These authors analyzed 707 histopathologic specimens of NS treated over a 13.6-year period. Most nevi were located on the scalp (63%), face (25%), and trunk (5%).The average age of patients was 27.4 years (range, newborn to 95 years).

Trichoblastoma was the most common benign tumor (7%), followed by syringocystadenoma papilliferum (5%). Malignant tumors were present in 2.5% of the specimens. Basal cell carcinoma was the most common malignancy (1.1%), followed by squamous cell carcinoma (0.6%). Nearly all malignant tumors were seen in adults. Secondary neoplasms were statistically related to age and anatomic site (P< 0.05). In the newborn to age 10 group, 0.7% had benign neoplasms; none had malignant tumors. In the 11- to 17-year-old group, 1.4% had benign neoplasms and 0.1% had malignant tumors. Among patients older than 18, 17% had benign neoplasms and 2.4% had malignant tumors. Two or more neoplasms were seen in 4% of patients, with trichoblastoma being the most common tumor in combination.


This study confirms that secondary growths in nevus sebaceus, while common, usually occur after adolescence. Furthermore, malignancy is uncommon, almost always presents after age 18, and is usually basal cell carcinoma. Thus, if elective excision is chosen, delaying surgery until adolescence, when the patient can undergo local anesthesia, is optimal. If located at less surgically amenable sites or where a scar may greatly worsen the appearance, observation by dermatology, with biopsy on an as-needed basis, is also appropriate.

Editor Disclosures at Time of Publication

  • Disclosures for Mary Wu Chang, MD at time of publication Consultant / Advisory board Valeant Speaker’s bureau Galderma


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