Nevus Verrucosus

A medium-sized brown pigmented lesion had been present on the right temple of a 61-year-old man since birth. The patient complained that during the last several months the lesion had formed a fine scale and begun to itch. Actinic keratoses and inclusion cysts were also noted on his face. Dr Robert P. Blereau of Morgan City, La, reports that an incisional biopsy showed papillomatosis and acanthosis with overlying hyperkeratosis: features of an epidermal nevus. In addition, there was mild, superficial perivascular chronic inflammation and prominent solar elastosis without atypia. The clinical pattern of this epidermal nevus was that of nevus verrucosus. The patient refused treatment of the benign lesion. The therapeutic options include topical 5-fluorouracil and tretinoin cream. Dermabrasion and cryotherapy can also be tried; however, the risk of recurrence is greater with these interventions. Excision of the entire lesion is the most predictable method of cure; for the optimum cosmetic result, consider referring the patient to a plastic surgeon.