Case Report: Leathery black plaque on the temple and scalp

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It typically manifests as a single yellowish plaque across the head and neck and is composed of sebaceous glands. It commonly occurs during infancy and grows during puberty. Usually, it follows a benign course; however, in a few cases, it can be malignant. This is the case of a 13-year-old child with verrucous plaques on the temple and scalp. Case report We report the case of a 13-year-old boy with a steadily developing hyperpigmented verrucous plaque on the scalp and ipsilateral side of his face. A dermoscopic examination revealed ridges and fissures in a cerebriform pattern with yellowish-gray globules and a papillary appearance. Physical examination and laboratory tests revealed no abnormalities. Biopsies were taken from the scalp and temple area, and the findings were consistent with the diagnosis of nevus sebaceous. The patient was referred to a plastic surgeon for a staged excision. Conclusions We describe a unique example of a sebaceous nevus that affected the scalp and ipsilateral side of the face. As this hamartomatous growth carries the risk of cancer development, a dermatologist must identify the condition and begin treatment before malignant transformation occurs. This example of multiple verrucous plaques is an exception. 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F1000Research 2024, 12 :1514 ( https://doi.org/10.12688/f1000research.142548.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Revised Case Report: Leathery black plaque on the temple and scalp [version 2; peer review: 2 approved] Kaveri Rusia https://orcid.org/0000-0001-6484-5844 1 , Bhushan Madke https://orcid.org/0000-0003-2704-9165 1 , Soham Meghe https://orcid.org/0009-0001-1382-897X 1 , Yash Kashikar https://orcid.org/0009-0008-6270-5299 1 Kaveri Rusia https://orcid.org/0000-0001-6484-5844 1 , Bhushan Madke https://orcid.org/0000-0003-2704-9165 1 , Soham Meghe https://orcid.org/0009-0001-1382-897X 1 , Yash Kashikar https://orcid.org/0009-0008-6270-5299 1 PUBLISHED 08 Apr 2024 Author details Author details 1 Department of Dermatology, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India Kaveri Rusia Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Bhushan Madke Roles: Conceptualization, Formal Analysis, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Soham Meghe Roles: Conceptualization, Formal Analysis, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Yash Kashikar Roles: Conceptualization, Data Curation, Investigation, Methodology, Project Administration, Resources, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Datta Meghe Institute of Higher Education and Research collection. Abstract Background Epidermal nevus sebaceous, commonly known as the nevus sebaceous of Jadassohn, is a congenital sebaceous hamartoma. It typically manifests as a single yellowish plaque across the head and neck and is composed of sebaceous glands. It commonly occurs during infancy and grows during puberty. Usually, it follows a benign course; however, in a few cases, it can be malignant. This is the case of a 13-year-old child with verrucous plaques on the temple and scalp. Case report We report the case of a 13-year-old boy with a steadily developing hyperpigmented verrucous plaque on the scalp and ipsilateral side of his face. A dermoscopic examination revealed ridges and fissures in a cerebriform pattern with yellowish-gray globules and a papillary appearance. Physical examination and laboratory tests revealed no abnormalities. Biopsies were taken from the scalp and temple area, and the findings were consistent with the diagnosis of nevus sebaceous. The patient was referred to a plastic surgeon for a staged excision. Conclusions We describe a unique example of a sebaceous nevus that affected the scalp and ipsilateral side of the face. As this hamartomatous growth carries the risk of cancer development, a dermatologist must identify the condition and begin treatment before malignant transformation occurs. This example of multiple verrucous plaques is an exception. READ ALL READ LESS Keywords hamartoma, nevus sebaceous, scalp, case report Corresponding Author(s) Kaveri Rusia ( [email protected] ) Close Corresponding author: Kaveri Rusia Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Rusia K et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Rusia K, Madke B, Meghe S and Kashikar Y. Case Report: Leathery black plaque on the temple and scalp [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1514 ( https://doi.org/10.12688/f1000research.142548.2 ) First published: 27 Nov 2023, 12 :1514 ( https://doi.org/10.12688/f1000research.142548.1 ) Latest published: 08 Apr 2024, 12 :1514 ( https://doi.org/10.12688/f1000research.142548.2 ) Revised Amendments from Version 1 We have added the differentiating points between the close differential diagnosis of Nevus Sebaceous, how to clinically identify the malignant transformation in the case of Nevus Sebaceous, and various non-invasive investigations for the same with genetics. We have added the differentiating points between the close differential diagnosis of Nevus Sebaceous, how to clinically identify the malignant transformation in the case of Nevus Sebaceous, and various non-invasive investigations for the same with genetics. See the authors' detailed response to the review by Aswath Rajan See the authors' detailed response to the review by Dipanjan Basu READ REVIEWER RESPONSES Introduction Nevus sebaceous (NS), initially described by Jadassohn, is a complicated hamartoma that typically develops on the face or scalp and has an epithelial or adnexal origin. 1 It can appear at birth or develop in infancy and increases during puberty, suggesting a hormonal influence. It can occasionally be found in other locations, such as the trunk or the oral or vaginal mucosa, although it mostly affects the scalp. Less frequently, it affects the preauricular area and neck. 2 Nevus sebaceous of Jadassohn (NSJ) develops in three stages. It manifests as isolated, well-circumscribed, smooth, yellowish plaques without hair during the infantile period. It becomes more noticeable with a verrucous or mamillated appearance during puberty. The last stage is characterised by peripheral telangiectasias and a nodular or tumoral appearance. 3 Many neoplasms develop alongside NS as proliferative growth begins. Both benign and malignant tumors have been reported to grow in NS. NS can be a site of basal cell cancer, syringocystadenoma papilliferum, trichoblastoma, and hidradenoma. 4 Case report A 13-year-old boy visited the dermatology outpatient department on 8 th September 2023 with a raised lesion on his scalp since birth and a lesion that had spread to the left side of the face over ten years. The ophthalmological, neurological, or cutaneous systems did not exhibit any abnormalities during physical examination. These skin lesions had not previously occurred in the family. The results of all laboratory tests, including the kidney function test, liver function test, urine examination, and complete blood count were within normal ranges. The patient had no other complaints. On cutaneous examination, a well-demarcated hyperpigmented verrucous plaque with a size of 8 × 4 cm was present on the frontal area of the scalp extending down to involve the forehead and a 7 × 3 cm plaque was present on the temporoparietal area and left preauricular area [ Figure 1 ]. Based on the patient’s medical history and physical examination, the possible differential diagnoses were identified as congenital melanocytic nevus, giant seborrhoeic keratoses, and verrucous epidermal nevus. However, a thorough examination through dermoscopy and histology conclusively ruled out these possibilities. In seborrheic keratosis, other than ridges and fissures multiple milia and comedone-like openings will be there. In acanthosis nigricans, there will be papillary projections with hyperpigmented dots and perifollicular pigmentation. We confirmed on clinical grounds that there were no clinical signs in the lesion to undergo a malignant transformation like ulceration, bleeding from the lesion or sudden increase in the size of the lesion. On dermoscopic examination, ridges and fissures were present in a cerebriform pattern with yellowish-grey globules and a papillary appearance [ Figure 2 ]. Histopathological examination revealed acanthosis, papillomatosis, and mild hyperkeratosis. There were immature and mature sebaceous glands with sebaceous hyperplasia and primitive hair follicles [ Figure 3 ]. The diagnosis of nevus sebaceous was established based on clinical presentation, dermoscopic findings, and histological analysis. The patient was referred to a plastic surgeon on 8 th September 2023 for a staged surgical excision of the nevus sebaceous. Our dermatology department does not offer plastic surgery services, hence the referral. Unfortunately, the patient was lost to follow-up after the referral, and we do not have any further information available. Figure 1. Verrucous plaque on frontal, temporal and preauricular area. (Written informed consent for publication of their clinical details and clinical images was obtained from the relatives of the patient). Figure 2. Ridges and fissures in a cerebriform pattern with yellowish grey globules and papillary appearance. Figure 3. There are immature and mature sebaceous gland with sebaceous hyperplasia along with primitive hair follicles with acanthosis, acanthosis, papillomatosis and mild hyperkeratosis of epidermis. Discussion Nevus sebaceous is a condition that appears at birth and increases in size with age. The exact cause of this condition is still uncertain, but recent studies have shown that it may be linked to women who have tested positive for the human papillomavirus or carry mutations in the PTCH gene. 5 , 6 Nevus sebaceous can present as one of the manifestations of Epidermal Nevus Syndrome. 7 There are some hereditary syndromes, including didymosis aplasticosebacea and SCALP (sebaceous nevus, central nervous system malformations, aplasia cutis congenita, limbal dermoid, and pigmented nevus) syndrome, that may present nevus sebaceous as a symptom. This condition typically appears as a smooth, yellowish-orange, round, oval, or linear plaque, mostly on the scalp, leading to alopecia. 5 A previous study found that nevus sebaceous can occur in multiple locations, similar to verrucous epidermal nevi. 8 Nevus sebaceous is rarely reported in the literature to affect the scalp and ipsilateral side of the face. 9 In our case, the scalp and the ipsilateral side of the face were affected. Several discussions have taken place regarding the emergence of secondary benign and malignant tumors inside the nevus sebaceous. While basal cell carcinoma development has been documented by multiple authors in adults, recent reports have also identified atypical malignant neoplasms such as eccrine porocarcinoma, sebaceous carcinoma, apocrine carcinoma, and squamous cell carcinoma developing inside the NS. 10 , 11 There is a risk of developing malignant tumors in the Nevus Sebaceous. To detect these tumors accurately, non-invasive techniques like High-frequency Ultrasound and Reflectance Confocal Microscopy are used. These techniques help in visualizing the skin and skin appendages for accurate depth and lateral border detection. Reflectance Confocal Microscopy is particularly useful as it allows for in vivo evaluation of lesions and shows both anatomical features and individual cells. 12 , 13 The presence of PTCH deletion, HRAS, and KRAS mutation can lead to malignant transformation in the nevus sebaceous. 14 Although the timing of resection for nevus sebaceous therapy is debatable, most researchers feel that surgical excision is the preferred course of action. However, surgical excision to remove nevus sebaceous creates a linear scar. There are various therapeutic options, such as CO 2 laser therapy, to reduce scarring. However, CO 2 laser vaporization completely eradicates the sebaceous section of the nevus, which is located in the epidermis or papillary dermis. 15 Conclusions The primary take-away lesson from our case is as follows: We describe a unique example of a sebaceous nevus that affected the scalp and ipsilateral side of the face. As this hamartomatous growth carries the risk of cancer development, a dermatologist must identify the condition and begin treatment before malignant transformation occurs. This example of multiple verrucous plaques is an exception. Consent Written informed consent for publication of their clinical details and clinical images was obtained from the relatives of the patient. Data availability All data underlying the results are available as part of the article and no additional source data are required. References 1. Lin HC, Lee JY, Shieh SJ, et al. : Large, papillomatous, and pedunculated nevus sebaceous. J. Dermatol. 2011 Feb; 38 (2): 200–202. PubMed Abstract | Publisher Full Text 2. Kelati A, Baybay H, Gallouj S, et al. : Dermoscopic analysis of nevus sebaceus of Jadassohn: a study of 13 cases. Skin Appendage Disord. 2017 May 2; 3 (2): 83–91. PubMed Abstract | Publisher Full Text | Free Full Text 3. Sahu P, Lakra S, Dayal S: Nevus sebaceous on face: Histopathological and dermoscopic correlation. Indian Dermatol. Online J. 2020 Sep; 11 (5): 878. Publisher Full Text 4. Ankad BS, Beergouder SL, Domble V: Trichoscopy: the best auxiliary tool in the evaluation of nevus sebaceous. Int. J. Trichology. 2016 Jan; 8 (1): 5–10. PubMed Abstract | Publisher Full Text | Free Full Text 5. Moody MN, Landau JM, Goldberg LH: Nevus sebaceous revisited. Pediatr. Dermatol. 2012 Jan; 29 (1): 15–23. PubMed Abstract | Publisher Full Text 6. Carlson JA, Cribier B, Nuovo G, et al. : Epidermodysplasia verruciformis–associated and genital-mucosal high-risk human papillomavirus DNA are prevalent in nevus sebaceus of Jadassohn. J. Am. Acad. Dermatol. 2008 Aug 1; 59 (2): 279–294. PubMed Abstract | Publisher Full Text 7. Happle R: The group of epidermal nevus syndromes: Part I. Well defined phenotypes. J. Am. Acad. Dermatol. 2010 Jul 1; 63 (1): 1–22. PubMed Abstract | Publisher Full Text 8. Cribier B, Scrivener Y, Grosshans E: Tumors arising in nevus sebaceus: a study of 596 cases. J. Am. Acad. Dermatol. 2000 Feb 1; 42 (2): 263–268. PubMed Abstract | Publisher Full Text 9. Chi SG, Kim JY, Kim HY, et al. : Multiple nevus sebaceous occurring on the scalp and on the contralateral side of the face. Ann. Dermatol. 2011 Aug 1; 23 (3): 389–391. PubMed Abstract | Publisher Full Text | Free Full Text 10. Correale D, Ringpfeil F, Rogers M: Large, papillomatous, pedunculated nevus sebaceus: a new phenotype. Pediatr. Dermatol. 2008 May; 25 (3): 355–358. PubMed Abstract | Publisher Full Text 11. Jadassohn J: Bemerkungen zur histology der systematisierten naevi und ubertigdrusen naevi. Arch. Dermatol. Syphilol. 1895; 33 : 355–372. Publisher Full Text 12. Bezugly A, Sedova T, Belkov P, et al. : Nevus sebaceus of Jadassohn-High frequency ultrasound imaging and videodermoscopy examination. Case presentation. Med. Pharm. Rep. 2021 Jan; 94 (1): 112–117. PubMed Abstract | Publisher Full Text 13. Voiculescu VM, Celarel AM, Cozma EC, et al. : Nevus Sebaceous of Jadassohn in Adults—Can Reflectance Confocal Microscopy Detect Malignant Transformation? Diagnostics. 2023 Apr 20; 13 (8): 1480. PubMed Abstract | Publisher Full Text | Free Full Text 14. Lee YJ, Han HJ, Kim DY, et al. : Malignant transformation of nevus sebaceous to basal-cell carcinoma: Case series, literature review, and management algorithm. Medicine. 2022 Aug 5; 101 (31): e29988. PubMed Abstract | Publisher Full Text | Free Full Text 15. Ashinoff R: Linear nevus sebaceus of Jadassohn treated with the carbon dioxide laser. Pediatr. Dermatol. 1993 Jun; 10 (2): 189–191. PubMed Abstract | Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 27 Nov 2023 ADD YOUR COMMENT Comment Author details Author details 1 Department of Dermatology, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India Kaveri Rusia Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Bhushan Madke Roles: Conceptualization, Formal Analysis, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Soham Meghe Roles: Conceptualization, Formal Analysis, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Yash Kashikar Roles: Conceptualization, Data Curation, Investigation, Methodology, Project Administration, Resources, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 08 Apr 2024, 12:1514 https://doi.org/10.12688/f1000research.142548.2 version 1 Published: 27 Nov 2023, 12:1514 https://doi.org/10.12688/f1000research.142548.1 Copyright © 2024 Rusia K et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Rusia K, Madke B, Meghe S and Kashikar Y. Case Report: Leathery black plaque on the temple and scalp [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1514 ( https://doi.org/10.12688/f1000research.142548.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 08 Apr 2024 Revised Views 0 Cite How to cite this report: Rajan A. Reviewer Report For: Case Report: Leathery black plaque on the temple and scalp [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1514 ( https://doi.org/10.5256/f1000research.164539.r264025 ) The direct URL for this report is: https://f1000research.com/articles/12-1514/v2#referee-response-264025 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 02 May 2024 Aswath Rajan , Goa Medical College, Goa, India Approved VIEWS 0 https://doi.org/10.5256/f1000research.164539.r264025 Well written, ... Continue reading READ ALL Well written, relevant corrections made. Competing Interests: No competing interests were disclosed. Reviewer Expertise: dermatology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Rajan A. Reviewer Report For: Case Report: Leathery black plaque on the temple and scalp [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1514 ( https://doi.org/10.5256/f1000research.164539.r264025 ) The direct URL for this report is: https://f1000research.com/articles/12-1514/v2#referee-response-264025 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 27 Nov 2023 Views 0 Cite How to cite this report: Rajan A. Reviewer Report For: Case Report: Leathery black plaque on the temple and scalp [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1514 ( https://doi.org/10.5256/f1000research.156109.r251438 ) The direct URL for this report is: https://f1000research.com/articles/12-1514/v1#referee-response-251438 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 28 Mar 2024 Aswath Rajan , Goa Medical College, Goa, India Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.156109.r251438 Article is very well written. However here are following few suggestions/queries that could add more value to it. I had copied your statement mentioned in bold letters and its queries below it. here as follows, 1. "As ... Continue reading READ ALL Article is very well written. However here are following few suggestions/queries that could add more value to it. I had copied your statement mentioned in bold letters and its queries below it. here as follows, 1. "As this hamartomatous growth carries the risk of cancer development, a dermatologist must identify the condition and begin treatment before malignant transformation occurs" Q: a) as the lesion is bigger, how did you confirmed that malignant transformation had not occurred in the lesion. what was the measures taken to identify malignancy change in the entire lesion. b) Was dermoscopy performed over the entire lesion! Was biopsy done on any suspicious part! ​​​​​​2. "The results of all laboratory tests, including the kidney function test, liver function test, urine examination, and complete blood count were within normal ranges." Q: what was the relevance and what laboratory abnormalities can be possibly expected in such cases. 3. "On dermoscopic examination, ridges and fissures were present in a cerebriform pattern with yellowish-grey globules and a papillary appearance" Q: a) several dermoscopic features were missed out. Dermoscopy is the key factor in this case. As the biopsy cant be done over the entire lesion, dermoscopy can bridge the gap between clinical and histopathological findings. b) ridges and fissures seen in several other conditions like seborrheic keratosis, acanthosis nigricans, nevus. So What was the classical features in this case. c) mention about the clods/globules of different sizes and shapes d) several clods are black (indicates keratinous plug), bright black dots/globules indicates that it communicate with surface, whereas the dull black are intraepidermal one. e) was the biopsy performed on the same dermoscopic site. d) mention other close dermoscopic differential diagnosis and one or two points on its differentiation. 4. "Several discussions have taken place regarding the emergence of secondary benign and malignant tumors inside the nevus sebaceous" Q: kindly mention for the readers, what are the possible clinical features that alerts the malignant change and its relevant investigations for early detection of local and systemic invasion with their likely management 5." As this hamartomatous growth carries the risk of cancer development, a dermatologist must identify the condition and begin treatment before malignant transformation occurs". Q: Malignant transformation was repeatedly emphasized in the article. So Mention the role of latest non-invasive skin imaging technique such as high-frequency ultrasound, multispectral imaging , optical coherence tomography, reflectance confocal microscopy etc. also mention a word on molecular/genetic study if reported earlier for early diagnosis of malignancy. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: dermatology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Rajan A. Reviewer Report For: Case Report: Leathery black plaque on the temple and scalp [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1514 ( https://doi.org/10.5256/f1000research.156109.r251438 ) The direct URL for this report is: https://f1000research.com/articles/12-1514/v1#referee-response-251438 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 13 Apr 2024 Kaveri Rusia , Department of Dermatology, Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India 13 Apr 2024 Author Response Thank you for your comments. 1) We confirmed on clinical grounds that there were no clinical signs in the lesion to undergo a malignant transformation like ulceration, bleeding from ... Continue reading Thank you for your comments. 1) We confirmed on clinical grounds that there were no clinical signs in the lesion to undergo a malignant transformation like ulceration, bleeding from the lesion or sudden increase in the size of the lesion. A dermoscopy was performed on the entire lesion and in the manuscript we have shown the characteristic features. On clinical examination, there were no suspicious parts to undergo malignant transformation so a biopsy was performed from a random site. 2) We performed the laboratory investigations since such cases may need surgical excision. 3) We have included the characteristic dermoscopic findings which were present in our case which is yellowish globules aggregated in clusters on a yellow background with cerebriform pattern of sulci and gyri. In seborrheic keratosis, other than ridges and fissures multiple milia and comedone-like openings will be there. In acanthosis nigricans, there will be papillary projections with hyperpigmented dots and perifollicular pigmentation. 4) The process of malignant degeneration is often accompanied by rapid morphological changes and other symptoms. Some of the morphological changes and symptoms include a change in the color of the skin, protruding mass, ulceration, change in size, and itching. Reflectance Confocal Microscopy can be performed to detect the malignant transformation. 5) The non-invasive techniques like High-frequency Ultrasound are used to visualize skin and skin appendages for accurate depth and lateral border detection for skin malignant and benign tumors. The reflectance confocal microscopy allows in vivo evaluation of lesion of the microscopic extension of lesion and shows both anatomical features and individual cells. The presence of PTCH deletion, HRAS, KRAS mutation leads to malignant transformation in the nevus sebaceous. Thank you for your comments. 1) We confirmed on clinical grounds that there were no clinical signs in the lesion to undergo a malignant transformation like ulceration, bleeding from the lesion or sudden increase in the size of the lesion. A dermoscopy was performed on the entire lesion and in the manuscript we have shown the characteristic features. On clinical examination, there were no suspicious parts to undergo malignant transformation so a biopsy was performed from a random site. 2) We performed the laboratory investigations since such cases may need surgical excision. 3) We have included the characteristic dermoscopic findings which were present in our case which is yellowish globules aggregated in clusters on a yellow background with cerebriform pattern of sulci and gyri. In seborrheic keratosis, other than ridges and fissures multiple milia and comedone-like openings will be there. In acanthosis nigricans, there will be papillary projections with hyperpigmented dots and perifollicular pigmentation. 4) The process of malignant degeneration is often accompanied by rapid morphological changes and other symptoms. Some of the morphological changes and symptoms include a change in the color of the skin, protruding mass, ulceration, change in size, and itching. Reflectance Confocal Microscopy can be performed to detect the malignant transformation. 5) The non-invasive techniques like High-frequency Ultrasound are used to visualize skin and skin appendages for accurate depth and lateral border detection for skin malignant and benign tumors. The reflectance confocal microscopy allows in vivo evaluation of lesion of the microscopic extension of lesion and shows both anatomical features and individual cells. The presence of PTCH deletion, HRAS, KRAS mutation leads to malignant transformation in the nevus sebaceous. Competing Interests: Authors declare no competing interests Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 13 Apr 2024 Kaveri Rusia , Department of Dermatology, Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India 13 Apr 2024 Author Response Thank you for your comments. 1) We confirmed on clinical grounds that there were no clinical signs in the lesion to undergo a malignant transformation like ulceration, bleeding from ... Continue reading Thank you for your comments. 1) We confirmed on clinical grounds that there were no clinical signs in the lesion to undergo a malignant transformation like ulceration, bleeding from the lesion or sudden increase in the size of the lesion. A dermoscopy was performed on the entire lesion and in the manuscript we have shown the characteristic features. On clinical examination, there were no suspicious parts to undergo malignant transformation so a biopsy was performed from a random site. 2) We performed the laboratory investigations since such cases may need surgical excision. 3) We have included the characteristic dermoscopic findings which were present in our case which is yellowish globules aggregated in clusters on a yellow background with cerebriform pattern of sulci and gyri. In seborrheic keratosis, other than ridges and fissures multiple milia and comedone-like openings will be there. In acanthosis nigricans, there will be papillary projections with hyperpigmented dots and perifollicular pigmentation. 4) The process of malignant degeneration is often accompanied by rapid morphological changes and other symptoms. Some of the morphological changes and symptoms include a change in the color of the skin, protruding mass, ulceration, change in size, and itching. Reflectance Confocal Microscopy can be performed to detect the malignant transformation. 5) The non-invasive techniques like High-frequency Ultrasound are used to visualize skin and skin appendages for accurate depth and lateral border detection for skin malignant and benign tumors. The reflectance confocal microscopy allows in vivo evaluation of lesion of the microscopic extension of lesion and shows both anatomical features and individual cells. The presence of PTCH deletion, HRAS, KRAS mutation leads to malignant transformation in the nevus sebaceous. Thank you for your comments. 1) We confirmed on clinical grounds that there were no clinical signs in the lesion to undergo a malignant transformation like ulceration, bleeding from the lesion or sudden increase in the size of the lesion. A dermoscopy was performed on the entire lesion and in the manuscript we have shown the characteristic features. On clinical examination, there were no suspicious parts to undergo malignant transformation so a biopsy was performed from a random site. 2) We performed the laboratory investigations since such cases may need surgical excision. 3) We have included the characteristic dermoscopic findings which were present in our case which is yellowish globules aggregated in clusters on a yellow background with cerebriform pattern of sulci and gyri. In seborrheic keratosis, other than ridges and fissures multiple milia and comedone-like openings will be there. In acanthosis nigricans, there will be papillary projections with hyperpigmented dots and perifollicular pigmentation. 4) The process of malignant degeneration is often accompanied by rapid morphological changes and other symptoms. Some of the morphological changes and symptoms include a change in the color of the skin, protruding mass, ulceration, change in size, and itching. Reflectance Confocal Microscopy can be performed to detect the malignant transformation. 5) The non-invasive techniques like High-frequency Ultrasound are used to visualize skin and skin appendages for accurate depth and lateral border detection for skin malignant and benign tumors. The reflectance confocal microscopy allows in vivo evaluation of lesion of the microscopic extension of lesion and shows both anatomical features and individual cells. The presence of PTCH deletion, HRAS, KRAS mutation leads to malignant transformation in the nevus sebaceous. Competing Interests: Authors declare no competing interests Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Basu D. Reviewer Report For: Case Report: Leathery black plaque on the temple and scalp [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1514 ( https://doi.org/10.5256/f1000research.156109.r241167 ) The direct URL for this report is: https://f1000research.com/articles/12-1514/v1#referee-response-241167 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 23 Feb 2024 Dipanjan Basu , Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Approved VIEWS 0 https://doi.org/10.5256/f1000research.156109.r241167 Nevus sebaceous of Jadassohn is known as a rare congenital malformation, grouped under hamartomas. Etiology is thought to be driven by somatic post-zygotic mutations in RAS genes among others. The clinical manifestation occurs as plaques and is commonly found on ... Continue reading READ ALL Nevus sebaceous of Jadassohn is known as a rare congenital malformation, grouped under hamartomas. Etiology is thought to be driven by somatic post-zygotic mutations in RAS genes among others. The clinical manifestation occurs as plaques and is commonly found on scalp and face, usually presenting with a verrucous appearance. The current study under review discusses a case of a 13-year-old child with verrucous plaques on the temple and scalp. The authors describe the case as Nevus sebaceous of Jadassohn based on clinical, dermoscopic and histological analysis. The case exhibits classic characteristics of a sebaceous nevus including hyperplasia of sebaceous glands. The incidence of nevus sebaceus is estimated approximately at 0.1% to 0.3% of all newborns without bias for sex or ethnicity. This case report is a valuable addition to previous reports to understand the nuances of this condition and would be a valuable source of knowledge for students and practicing clinicians. The authors described the background of the case’s history and progression in adequate detail including reference to current literature. However, the authors may include that RAS genes are also implicated in the development of this condition (See Ref [1],[2]. The authors describe in detail the process of diagnosis presenting appropriately labeled representative figures. However, it would be helpful for the readers if the histological images are presented with a scale bar of magnification. Overall, a well-presented case report to add to the existing knowledge on this congenital malformation. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Yes References 1. Lena C, Kondo R, Nicolacópulos T: Do you know this syndrome? Schimmelpenning-Feuerstein-Mims syndrome. Anais Brasileiros de Dermatologia . 2019; 94 (2): 227-229 Publisher Full Text 2. Lihua J, Feng G, Shanshan M, Jialu X, et al.: Somatic KRAS mutation in an infant with linear nevus sebaceous syndrome associated with lymphatic malformations: A case report and literature review. Medicine (Baltimore) . 2017; 96 (47): e8016 PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Cell biology and therapeutic strategies of Large /giant congenital nevi and neurocutaneous melanocytosis. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Basu D. Reviewer Report For: Case Report: Leathery black plaque on the temple and scalp [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1514 ( https://doi.org/10.5256/f1000research.156109.r241167 ) The direct URL for this report is: https://f1000research.com/articles/12-1514/v1#referee-response-241167 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 13 Apr 2024 Kaveri Rusia , Department of Dermatology, Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India 13 Apr 2024 Author Response Thank you for your response. Competing Interests: No competing interests Thank you for your response. Thank you for your response. Competing Interests: No competing interests Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 13 Apr 2024 Kaveri Rusia , Department of Dermatology, Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India 13 Apr 2024 Author Response Thank you for your response. Competing Interests: No competing interests Thank you for your response. Thank you for your response. Competing Interests: No competing interests Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 27 Nov 2023 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 2 (revision) 08 Apr 24 read Version 1 27 Nov 23 read read Dipanjan Basu , University of Pittsburgh, Pittsburgh, USA Aswath Rajan , Goa Medical College, Goa, India Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Rajan A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 02 May 2024 | for Version 2 Aswath Rajan , Goa Medical College, Goa, India 0 Views copyright © 2024 Rajan A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Well written, relevant corrections made. Competing Interests No competing interests were disclosed. Reviewer Expertise dermatology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Rajan A. Peer Review Report For: Case Report: Leathery black plaque on the temple and scalp [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1514 ( https://doi.org/10.5256/f1000research.164539.r264025) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-1514/v2#referee-response-264025 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Rajan A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 28 Mar 2024 | for Version 1 Aswath Rajan , Goa Medical College, Goa, India 0 Views copyright © 2024 Rajan A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Article is very well written. However here are following few suggestions/queries that could add more value to it. I had copied your statement mentioned in bold letters and its queries below it. here as follows, 1. "As this hamartomatous growth carries the risk of cancer development, a dermatologist must identify the condition and begin treatment before malignant transformation occurs" Q: a) as the lesion is bigger, how did you confirmed that malignant transformation had not occurred in the lesion. what was the measures taken to identify malignancy change in the entire lesion. b) Was dermoscopy performed over the entire lesion! Was biopsy done on any suspicious part! ​​​​​​2. "The results of all laboratory tests, including the kidney function test, liver function test, urine examination, and complete blood count were within normal ranges." Q: what was the relevance and what laboratory abnormalities can be possibly expected in such cases. 3. "On dermoscopic examination, ridges and fissures were present in a cerebriform pattern with yellowish-grey globules and a papillary appearance" Q: a) several dermoscopic features were missed out. Dermoscopy is the key factor in this case. As the biopsy cant be done over the entire lesion, dermoscopy can bridge the gap between clinical and histopathological findings. b) ridges and fissures seen in several other conditions like seborrheic keratosis, acanthosis nigricans, nevus. So What was the classical features in this case. c) mention about the clods/globules of different sizes and shapes d) several clods are black (indicates keratinous plug), bright black dots/globules indicates that it communicate with surface, whereas the dull black are intraepidermal one. e) was the biopsy performed on the same dermoscopic site. d) mention other close dermoscopic differential diagnosis and one or two points on its differentiation. 4. "Several discussions have taken place regarding the emergence of secondary benign and malignant tumors inside the nevus sebaceous" Q: kindly mention for the readers, what are the possible clinical features that alerts the malignant change and its relevant investigations for early detection of local and systemic invasion with their likely management 5." As this hamartomatous growth carries the risk of cancer development, a dermatologist must identify the condition and begin treatment before malignant transformation occurs". Q: Malignant transformation was repeatedly emphasized in the article. So Mention the role of latest non-invasive skin imaging technique such as high-frequency ultrasound, multispectral imaging , optical coherence tomography, reflectance confocal microscopy etc. also mention a word on molecular/genetic study if reported earlier for early diagnosis of malignancy. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise dermatology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 13 Apr 2024 Kaveri Rusia, Department of Dermatology, Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India Thank you for your comments. 1) We confirmed on clinical grounds that there were no clinical signs in the lesion to undergo a malignant transformation like ulceration, bleeding from the lesion or sudden increase in the size of the lesion. A dermoscopy was performed on the entire lesion and in the manuscript we have shown the characteristic features. On clinical examination, there were no suspicious parts to undergo malignant transformation so a biopsy was performed from a random site. 2) We performed the laboratory investigations since such cases may need surgical excision. 3) We have included the characteristic dermoscopic findings which were present in our case which is yellowish globules aggregated in clusters on a yellow background with cerebriform pattern of sulci and gyri. In seborrheic keratosis, other than ridges and fissures multiple milia and comedone-like openings will be there. In acanthosis nigricans, there will be papillary projections with hyperpigmented dots and perifollicular pigmentation. 4) The process of malignant degeneration is often accompanied by rapid morphological changes and other symptoms. Some of the morphological changes and symptoms include a change in the color of the skin, protruding mass, ulceration, change in size, and itching. Reflectance Confocal Microscopy can be performed to detect the malignant transformation. 5) The non-invasive techniques like High-frequency Ultrasound are used to visualize skin and skin appendages for accurate depth and lateral border detection for skin malignant and benign tumors. The reflectance confocal microscopy allows in vivo evaluation of lesion of the microscopic extension of lesion and shows both anatomical features and individual cells. The presence of PTCH deletion, HRAS, KRAS mutation leads to malignant transformation in the nevus sebaceous. View more View less Competing Interests Authors declare no competing interests reply Respond Report a concern Rajan A. Peer Review Report For: Case Report: Leathery black plaque on the temple and scalp [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1514 ( https://doi.org/10.5256/f1000research.156109.r251438) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-1514/v1#referee-response-251438 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Basu D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 23 Feb 2024 | for Version 1 Dipanjan Basu , Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA 0 Views copyright © 2024 Basu D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Nevus sebaceous of Jadassohn is known as a rare congenital malformation, grouped under hamartomas. Etiology is thought to be driven by somatic post-zygotic mutations in RAS genes among others. The clinical manifestation occurs as plaques and is commonly found on scalp and face, usually presenting with a verrucous appearance. The current study under review discusses a case of a 13-year-old child with verrucous plaques on the temple and scalp. The authors describe the case as Nevus sebaceous of Jadassohn based on clinical, dermoscopic and histological analysis. The case exhibits classic characteristics of a sebaceous nevus including hyperplasia of sebaceous glands. The incidence of nevus sebaceus is estimated approximately at 0.1% to 0.3% of all newborns without bias for sex or ethnicity. This case report is a valuable addition to previous reports to understand the nuances of this condition and would be a valuable source of knowledge for students and practicing clinicians. The authors described the background of the case’s history and progression in adequate detail including reference to current literature. However, the authors may include that RAS genes are also implicated in the development of this condition (See Ref [1],[2]. The authors describe in detail the process of diagnosis presenting appropriately labeled representative figures. However, it would be helpful for the readers if the histological images are presented with a scale bar of magnification. Overall, a well-presented case report to add to the existing knowledge on this congenital malformation. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Yes References 1. Lena C, Kondo R, Nicolacópulos T: Do you know this syndrome? Schimmelpenning-Feuerstein-Mims syndrome. Anais Brasileiros de Dermatologia . 2019; 94 (2): 227-229 Publisher Full Text 2. Lihua J, Feng G, Shanshan M, Jialu X, et al.: Somatic KRAS mutation in an infant with linear nevus sebaceous syndrome associated with lymphatic malformations: A case report and literature review. Medicine (Baltimore) . 2017; 96 (47): e8016 PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Cell biology and therapeutic strategies of Large /giant congenital nevi and neurocutaneous melanocytosis. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (1) Author Response 13 Apr 2024 Kaveri Rusia, Department of Dermatology, Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India Thank you for your response. View more View less Competing Interests No competing interests reply Respond Report a concern Basu D. Peer Review Report For: Case Report: Leathery black plaque on the temple and scalp [version 2; peer review: 2 approved] . F1000Research 2024, 12 :1514 ( https://doi.org/10.5256/f1000research.156109.r241167) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-1514/v1#referee-response-241167 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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