Risks and Treatment Options for Sebaceous Nevus in Children

What are the risks associated with sebaceous gland nevus surgery?

Hello Dr.
Hsiao,
I would like to ask about my daughter, who has a coin-sized area on her scalp where hair has not grown since birth.
Is this definitely a "sebaceous gland nevus"? I just came across this term online and learned that it is not just a cosmetic issue but something that needs to be addressed.
My daughter is now in kindergarten; does she definitely need surgery, or is laser treatment sufficient? (We are not concerned about the cosmetic aspect since her other hair can cover it, but we are worried about potential future complications.)
Additionally, what are the risks associated with surgery for a sebaceous gland nevus? Is there a risk to life? Will general anesthesia be required? Will she need to be hospitalized, and if so, for how many days? Is this age appropriate for the procedure, or should she be older?
Thank you.

Q Ma, 30~39 year old female. Ask Date: 2009/04/16

Dr. Xiao Kaiwen reply Pediatrics

Sebaceous gland nevi may have a chance of developing secondary malignant or benign tumors, with the occurrence of secondary changes typically happening after puberty.
There are two treatment methods: one is laser therapy, and the other is surgical excision.
Laser treatment can flatten the nevus with minimal scarring, but there is a possibility of recurrence.
Surgical excision may leave some scarring but is more effective in completely removing the lesion.
Regarding the timing of surgery, considering anesthesia (most procedures can be performed under local anesthesia in an outpatient setting without hospitalization, and general anesthesia is only considered in cases of extreme non-cooperation), it is generally recommended to wait until children are pre-pubertal.
It is advisable to remove the nevus after they start elementary school; however, it is important to consult a physician if there is a sudden increase in size or any changes prior to that for safety.

Reply Date: 2009/04/16

More Info

Sebaceous nevus, also known as nevus sebaceous, is a congenital skin condition characterized by a hairless patch of skin that may appear on the scalp or other areas of the body. It typically presents as a yellowish or orange-colored lesion and can vary in size. While many sebaceous nevi are benign and do not pose any immediate health risks, there are important considerations regarding their management, especially in children.

Understanding Sebaceous Nevus
Sebaceous nevus is formed from an overgrowth of sebaceous (oil) glands and can sometimes be associated with other skin conditions or syndromes. The primary concern with sebaceous nevi is the potential for them to undergo changes over time, including the risk of developing into skin cancer, particularly basal cell carcinoma, later in life. This risk is generally low, but it is a factor that parents should consider when discussing treatment options with their healthcare provider.

Treatment Options
1. Observation: If the nevus is asymptomatic and not causing any cosmetic concerns, a "watchful waiting" approach may be appropriate. Regular monitoring by a dermatologist can help ensure that any changes in the nevus are detected early.

2. Surgical Excision: If there are concerns about the nevus, such as changes in appearance, size, or texture, surgical excision may be recommended. This procedure involves removing the nevus along with a margin of healthy skin to ensure complete removal.
3. Laser Treatment: In some cases, laser therapy may be an option for reducing the appearance of the nevus without surgical excision. However, laser treatment may not completely remove the nevus and is typically more focused on cosmetic improvement.

Considerations for Surgery
- Age: Your daughter is currently in kindergarten, which is generally an acceptable age for surgical procedures. However, the decision should be made in consultation with a pediatric dermatologist or surgeon who can assess her specific case.

- Anesthesia: Surgical excision of a sebaceous nevus is typically performed under local anesthesia, especially for smaller lesions. In some cases, general anesthesia may be used, particularly if the lesion is large or if the child is anxious about the procedure. The choice of anesthesia will depend on the size of the nevus and the child's comfort level.

- Hospital Stay: Most excisions can be done on an outpatient basis, meaning your daughter would not need to stay overnight in the hospital. However, if general anesthesia is used or if there are complications, a short hospital stay may be required.

- Risks: As with any surgical procedure, there are risks involved, including infection, scarring, and adverse reactions to anesthesia. However, serious complications are rare.

Conclusion
In summary, while sebaceous nevus is generally benign, it is important to monitor it for any changes. Surgical excision is a common treatment option if there are concerns about potential complications or cosmetic issues. It is advisable to consult with a pediatric dermatologist who can provide personalized recommendations based on your daughter's specific condition. They can help you weigh the benefits and risks of surgery versus observation and discuss the best approach for your child's health and well-being.

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