DERMADIAGNOSIS

Ear “” Prompts Unkind Comments

n 8-year-old boy is re- ferred to for A evaluation and treat- ment of a “wart” on the inferior rim of his left helix that has been present (and unchanged) since birth. The is asymptom- atic, and the boy’s biggest com- plaint is that it makes him the object of unkind comments from his siblings and friends. The patient’s mother claims the child is otherwise healthy; there is no history of seizure or other neu- rologic problems, and he does not have any medical conditions re- quiring treatment. The lesion has been treated, unsuccessfully, with a variety of wart remedies, includ- ing salicylic acid-based products and liquid nitrogen. Along the inferior rim of the left helix is a 5-cm linear collec- tion of soft, -colored that range in size from pinpoint to 2.5 mm. They are so small and flesh-toned as to easily escape de- a) Wart (verruca vulgaris) “d”) were possible differential tection unless specifically sought. b) Nevus sebaceous items, the former usually appears No other significant are c) Trichofolliculoma much later in life and the latter is seen on the ear or elsewhere on d) Epidermal nevus usually more dry and rough to the the head or neck. touch. The child looks his stated age ANSWER and appears well developed and The correct answer is nevus seba- DISCUSSION well nourished. ceous (choice “b”), a rather com- Nevus sebaceous (NS) of Jadas- The most likely diagnostic ex- mon hamartomatous congenital sohn was first described in 1895 planation is tumor. The diagnosis was con- by a Swedish dermatologist who firmed by pathologic examination had seen a series of young pa- Joe R. Monroe, of a tiny sample from the most tients with hairless plaques in the MPAS, PA, practices­ papular portion of the lesion. scalp or on surrounding neck or at Dawkins Dermatology­ Clinic Given the lesion’s congenital facial skin. Pathologic exam con- in Oklahoma City. nature and complete lack of re- firmed them to be organoid nevi He is also the sponse to treatment, wart (choice representing an overgrowth of se- founder of the “a”) was quite unlikely. And al- baceous glands. Society of Dermatology­ though trichofolliculoma (choice Over time, it became clear that Physician­ Assistants.­ “c”) and epidermal nevus (choice NS affects all genders and races continued on page 17 >> clinicianreviews.com MAY 2016 • Clinician Reviews 13 DERMADIAGNOSIS

>> continued from page 13 equally. For most patients, the le- tion, especially in larger scalp le- Most cases of NS in the scalp sions are of cosmetic concern due sions that are subject to years of are easy to diagnose by their pink to the lack of hair. But it has also excess UV exposure. This was the color, plaquish morphology, and been established that NS can de- driving force behind the com- mammillated hairless surface velop in areas, including the face, mon practice of removing NS at (coupled with congenital mani- ears, and neck, on which they puberty. We now know that al- festation). But a few, such as may be cosmetically significant though basal or squamous cell this patient’s ear lesion, require and difficult to remove. carcinoma, or even , for confirmation. As this Concern arose when reports can develop in longstanding NS, patient ages, he may feel the need began to surface that NS could the frequency is probably far less to have the rest of it surgically re- undergo malignant transforma- than previously thought. moved. CR

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