Multiple Nevi in a 6-year-old Boy

Nneamaka C. Ezekwe; Jaspreet K. Oberoi; Robert T. Brodell

doi:10.1542/pir.2018-0225

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Nneamaka C. Ezekwe, BS*
Jaspreet K. Oberoi, MD^†
Robert T. Brodell, MD†,‡,§

^*School of Medicine,
^†Department of Pathology, and
^‡Department of Dermatology, University of Mississippi Medical Center, Jackson, MS
^§Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY

AUTHOR DISCLOSURE
Drs Ezekwe, Oberoi, and Brodell have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A 6-year-old boy presents with more than 25 asymptomatic “moles” on his neck and trunk. They have been present since infancy and have slowly increased in size and number. There was no recent enlargement, bleeding, itching, and/or pain. Benign macrocephaly was diagnosed at birth and his father had macrocephaly diagnosed in childhood. A maternal great grandfather had at least 1 basal cell carcinoma (BCC). There was no family history of dysplastic nevi or melanoma.

Physical examination revealed 25 tan to brown, 1- to 4-mm papules on the posterior neck and widely scattered over the trunk (see Fig 1a). There were no palmar pits. Bifid uvula and scoliosis were also noted.

Figure 1.

A. Multiple pigmented papules (highlighted by red arrows) are noted on the back of the neck. B. Hematoxylin and eosin (H&E) stained section shows palisading of basal cells at the periphery of the tumor (highlighted by black arrows), which is identical to the basal cell palisading of normal epidermis hence the name “basal cell carcinoma.” The tumor is surrounded by an eosinophilic desmoplastic stroma (highlighted by red arrows) (×20). C. H&E stained section shows a focus of mucin deposition within the tumor (highlighted by black arrow). Multiple areas with melanophages are noted in the adjacent dermis (highlighted by red arrows), which would contribute to the coloration of the papules (×200). D. H&E stained section shows higher power view of the basal cells with peripheral palisading (highlighted by black arrows) and surrounding desmoplastic reaction (highlighted by red arrows) (×400).

The lesions appeared to be benign nevi, but given the presentation of so many tan-brown papules in a prepubertal child, a …