Scalp Nevus

A 3-year-old boy presented to the clinic with a dark spot in his hair that measured 3 cm by 3 cm. The skin in this region was lightly pigmented, with dark hairs; the lesion had been more pigmented at birth. There was no pain, pruritus, or bleeding, and the lesion had no notable growth. A congenital nevomelanocytic nevus was diagnosed. Such nevi are often present at birth but can develop later in life.

Image from NEJM image challenge (link)

A 3-year-old boy presented to the clinic with a dark spot in his hair that measured 3 cm by 3 cm. The skin in this region was lightly pigmented, with dark hairs; the lesion had been more pigmented at birth. There was no pain, pruritus, or bleeding, and the lesion had no notable growth. A congenital nevomelanocytic nevus was diagnosed. Such nevi are often present at birth but can develop later in life. Congenital as compared with noncongenital nevomelanocytic nevi confer a high risk of transformation to melanoma. Although biopsy or excision is often considered for these nevi since they confer a high risk of transformation to melanoma, neither has been performed in this case, since the pigment is fading and the lesion is small and shrinking. Yearly dermatologic follow-up was recommended, and the patient and his parents were advised to alert the physician should changes appear.

additional image

Bertine Bast, M.D.
Danielle van Bommel-Slee, M.D.
Ziekenhuis Groep Twente Hospital, Almelo, the Netherlands

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