Type: Evaluation Essays
Sample donated: Simon Mckinney
Last updated: September 24, 2019
Cerebriform intradermal nevus is a rare manifestastion presenting as cutis verticis gyrata on the scalp.
These nevi have a high incidence rate of turning into melanoma with a life-time incidence rate between 6.3 and 12 percent (1). We present a case of this rare melanocytic process on the scalp of a 23 year old white female. The nature of the disease, clinical presentation, histological findings and the treatment plan is thoroughly described.A 23 year-old white female presented in the clinic with concerns about congenital nevi located all over her body. Her greatest concern was regarding one nevus on the forearm, which she reports might have been recently changing in color and size. She reported that she has had 15-20 of these larger nevi located all over the body, which have been present since birth. She had never been seen by a dermatologist in the past, nor has she had these lesions evaluated.
She reports that she has also had a unique “birthmark” on the scalp. She stated that it was asymptomatic and she was not concerned about the physical appearance, since it involved only part of the scalp and could be easily covered by her hair.Upon evaluation, the left frontal scalp extending to left occipital scalp measured an approximately 21 cm long plaque which was skin colored and exophytic composed of undulating skin folds. With a differential diagnosis of cutis verticis gyrata vs. cerebriform intradermal nevus, an excisional biopsy to confirm the diagnosis was indicated. The fact that the patient is female, the lesion has been present since birth and involves a portion of the scalp, and that she has various other congenital nevi suggest the later diagnosis. An excisional biopsy was done on the largest gyrus in the center of the scalp lesion and it was repaired by bringing together the surrounding sulci of the section.
The specimen was sent for pathology which showed a congenital nevus with atypical qualities. Genetic studies were done for melanoma which were inconclusive. With uncertain biological potential of the lesion, further surgical intervention is indicated especially considering the broad risk of malignant degeneration and for the fact that the specimen which was tested only represents a small portion of the overall lesion. MRI studies have been done and the treatment plan is to use scalp expanders, eventually removing the lesion in its entirety.