Baylor University Medical Center Proceedings April 2017 - 211

Evaluation and management of an unusual congenital nevus
K. Blaire Kerwin, BS, and M. Alan Menter, MD

Abnormal findings on routine skin exams are common and can be a
source of unnecessary medical workup if a clinician is unfamiliar with the
finding. Sebaceous nevi are rare skin lesions that are most often benign
but may be associated with a multiorgan syndrome or local skin cancer.
Dermatologists and primary care physicians may encounter these on
routine exams and thus must be comfortable with diagnosis and management. We present the clinical characteristics of a benign sebaceous
nevus to help aid in diagnosis of these lesions and outline suggestions
for appropriate management options.

he total body skin examination is one of the most common dermatologic visits and a common component of
primary care visits. Examining the skin for potential
malignancies can be taxing; therefore, eﬃcient evaluation is a necessity for high-volume clinics. Quick identiﬁcation of malignant features and conﬁdence in evaluating rare
nevi is fundamental to eﬃciency. We present a case describing
the evaluation and management of a rare, unusual-appearing
congenital nevus with neoplastic potential.
CASE DESCRIPTION
A 52-year-old white woman presented to the dermatology
clinic for a routine annual full-body skin exam and evaluation
of a suspicious lesion she noticed on her posterior auricular
skinfold. She was unsure how long the lesion had been present
but believed it to be growing in size over the past 5 years. She
denied pain, pruritus, bleeding, or drainage from the lesion
and denied ophthalmologic defects, neurologic symptoms, skeletal deformities, or a personal history of skin cancers.
The postauricular lesion was a linear, waxy, ﬂesh- and yellowcolored plaque that measured approximately 40 mm in length
(Figure). No erythema or drainage was noted. On palpation,
the lesion was ﬁrm and nonmobile, and sebum could not be
expressed. No punctum was identiﬁed. No other similar lesions
were found on the remainder of the skin exam, only benign nevi
and seborrheic keratoses.
The lesion was determined to be a single sebaceous nevus
based on texture, anatomic distribution, physical characteristics,
and presence for more than 5 years. A biopsy was not performed
as the lesion was not felt to have any signiﬁcant characteristics
Proc (Bayl Univ Med Cent) 2017;30(2):211-212

Figure. A 40-mm linear sebaceous nevus in the left posterior auricular region.

suggesting malignancy. The patient was counseled to observe the
lesion for continued growth, change in texture, ulceration, or
pruritus. The lesion was photographed to assist with monitoring
it over time, with plans for yearly follow-ups.
DISCUSSION
Sebaceous glands are sebum-secreting glands located in the
dermis of all hair-bearing skin and are associated with hair follicles
and apocrine ducts (1). Hormones strongly aﬀect the activity level
of these glands; thus, at the time of puberty, sebum production
increases. However, as an individual ages further, sebaceous glands
become diﬀusely hyperplastic, sebum production decreases, and
cell turnover and migration slow (2).

From Texas A&M College of Medicine (Kerwin, Menter), Baylor University Medical
Center at Dallas (Menter), and Texas Dermatology Associates, P.A., Dallas, Texas
(Menter).
Corresponding author: Blaire Kerwin, 4117 Wycliff Avenue, Dallas, TX 75219
(e-mail: kkerwin@medicine.tamhsc.edu).
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