Abdominal cerebriform intradermal nevus in a 22 years old female in the Eastern Region of Democratic Republic of Congo, A psychodermatological case report

Abdominal cerebriform intradermal nevus in a 22 years old female in the Eastern Region of Democratic Republic of Congo, A psychodermatological case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Abdominal cerebriform intradermal nevus in a 22 years old female in the Eastern Region of Democratic Republic of Congo, A psychodermatological case report INENA WA INENA Gaylord This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5765376/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Cerebriform intradermal nevi (CIN) are a rare subtype of intradermal melanocytic nevi, distinguished by their characteristic surface morphology that resembles the gyri and sulci of the human brain. Typically presenting as benign skin lesions, these nevi occur predominantly as congenital formations, often evident at birth or during early childhood.Females are more affected. CINs generally manifest in areas such as the scalp and face and can be mistaken for malignant conditions due to their distinctive appearance and potential for growth, which may be influenced by hormonal changes, particularly during puberty and pregnancy. An early diagnosis is crucial due to the associated risk of malignant melanoma, with lifetime incidence rates of melanoma in CINs ranging from 6.3% to 12%. Diagnosis is primarily clinical, supported by dermoscopy and, in uncertain cases, histopathological examination. Treatment options depend on factors such as cosmetic concerns and suspicion of malignancy, with complete excision being the most common intervention. This case report details a 21-year-old female patient with a cerebriform lesion on her flank, exacerbated by postpartum hormonal changes. The report highlights the psychological impact of such skin conditions, as the patient experienced anxiety and depression related to her lesion. Following a successful excisional biopsy and psycho-educational support, her mental health improved significantly. This case emphasizes the importance of recognizing the psychological implications of CINs and adopting a biopsychosocial approach to patient management to ensure optimal outcomes and patient satisfaction. Dermatology Nevus intradermal Cerebriform abdominal psychodermatology Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction Cerebriform intradermal nevi are a rare subtype of intradermal melanocytic nevi, characterized by their distinctive surface morphology resembling the gyri and sulci of the human brain[ 1 ]. These nevi typically present as benign, non-cancerous skin lesions and are classified within the broader category of melanocytic nevi, which result from the proliferation of melanocytes in the dermis[ 2 ]. Cerebriform intradermal nevi predominantly occur as congenital lesions, often present at birth or arising in early childhood[ 3 ].Regarding sex predilection, women are more affected than males [ 4 ]. The cerebriform appearance is due to an exaggerated surface architecture, often caused by the hypertrophy of the dermal components[ 3 , 5 ]. These nevi are generally asymptomatic, although their unusual texture and appearance may draw attention and prompt medical evaluation[ 5 ].They can vary in size and pigmentation, often appearing as raised, soft, or firm lesions with a flesh-colored, brown, or darker hue[ 3 ]. Cerebriform intradermal naevus are most commonly observed on the scalp or face but rarely may occur in other locations[ 6 ]. While they are benign, their unique morphology can occasionally mimic malignant conditions, necessitating careful clinical assessment to rule out malignancy[ 7 ]. Clinically it presents as asymmetric, skin‑colored or slightly pigmented tumor usually localized commonly over the scalp and rarely on the trunk and lower limb[ 8 ]. Over the years, it slowly enlarges and becomes more prominent and well demarcated with a cerebriform surface. Its size varies from 2 × 3 cm to 25 × 22.5 cm, and at times affects one half to three quarters of the scalp. Progressive alopecia is common, with hair being particularly sparse over the convolutions, and tufts emerging from the sulci. Patients may also have pruritus, tenderness, burning, recurrent infection, bleeding and a fetid and or musty odor[ 1 ]. These nevi are typically static or slow-growing.Pregnancy, hysterectomy, surgical exploration, and hormonal activity may induce a growth spurt of CIN[ 9 ]. It is suggested that increased hormonal activity may potentiate the growth of these lesions, as growth spurt is often noted at puberty[ 1 ]. Early diagnosis and treatment of CIN is important as the risk of development of malignant melanoma is high[ 7 ]. The life‑time incidence of melanoma arising in a giant nevus or in smaller nevi is 6.3% and 12%[ 4 ]. The melanoma may be present at birth, or it may arise in infancy or later in life. The mortality of such lesions is high[ 10 ]. Diagnosis is typically clinical, supplemented by dermoscopy, and in uncertain cases, histopathological examination is performed. Histological examination shows intradermal nevus cells present in the full thickness of the dermis which can be well delineated or irregular. Nevus cells contain varying amounts of melanin. Neuroid transformation can be present in the deeper parts of the lesion with increased collagen fibers simulating those observed in neurofibroma.The nests and nevus cells are observed merging with the neuroid tissue. Hair follicles may appear atrophied, with nevoid tissue densely abutting them[ 1 , 2 , 9 ]. They may require treatment only for cosmetic reasons, irritation, or suspicion of malignancy. Options include surgical excision and plastic reconstruction ,sometimes involving tissue expansion techniques. or laser therapy, depending on the size, location, and patient preference, In cases where excision is not possible, close follow‑up of the lesion is mandatory[ 4 , 11 – 13 ]. Although studies have not described cases of cerebriform intradermal nevi associated with mental disorders, a link has been established between disfiguring skin conditions and certain mental disorders, such as depression[ 14 ]. Many individuals associate unusual or irregular skin lesions with melanoma due to widespread awareness campaigns. The dramatic appearance of cerebriform intradermal nevi may amplify this fear.Patients might experience anxiety, insomnia, or even depression while awaiting diagnostic clarification. Persistent fear of recurrence or malignancy may linger even after a benign diagnosis. Understanding the characteristics and management of cerebriform intradermal nevus is essential for clinicians to distinguish early these benign lesions from potentially harmful dermatological conditions[ 6 ].This helps to calm and reassure patients with these lesions and to avoid unnecessary excisions. This case report aims to present not only a typical case of intradermal cerebriform nevus with a particular location and good evolution after excision which confirms the existing literature in the field, but also the psychological impact of this skin conditions and the effectiveness of biopsychological approach in the management of patients with skin conditions[ 15 ]. Description of the case A 21-year-old female, from BENI(KIVU) ,married ,with 2 children (the last born is 3 months old,female) presented with complaints of a black mass on the skin of her left flank. The patient also complained of a feeling of permanent fear, anxiety, and insomnia during the last 4 weeks due to the postpartum increase in the size of the mass because the lesion was first noticed at birth and gradually increased in size with age and more after the birth of her second male child.She reported no family history of skin disorders. On examination,an ovoid nodule with a long oblique axis (5x3 cm), rough to the touch, well demarcated in relation to the surrounding healthy skin, irregular edges in some areas. The surface was irregular with convolutions and depressions, the area was hairless upon inspection, no itching or painful sensation,no fetid odor ( Fig. 1 ) and no other dermatological lesions in others part of the body.The patient had a preserved general condition, without any significant founding in examination of other systems. The Hopkins Symptom Checklist-25(HSCL-25)was administered to the patient to measure symptoms of anxiety and depression and screened positive for depression and anxiety (For Depression :32/15 = 2,13 > 1.75 cut-off ; For Anxiety 21/10 = 2.10 > 1.75 cut-off ). Psycho-education about the condition was administered to the patient and the care taker and to allow them to understand the procedure and the good prognosis of the condition and a written informed consent was obtained from the patient A total excisional biopsy of the nodule by taking over 2 cm of healthy skin beyond the nodule and in depth ( Fig. 2 ) on local anesthesia (lidocaine 2% plus 1mg of adrenaline) showed a cerebriform mass lined by benign keratinizing squamous epithelium. The underlying dermis was diffusely infiltrated by Type A melanocytes (epithelioid large with distinct cell borders and melanin pigment) in superficial dermis and Type B melanocytes 9 smaller with less pigment) in the intermediate dermis. No mitoses, necrosis or marked atypia seen. These features were suggestive of a cerebriform intradermal naevus ( Fig. 4 ) . The wound was sutured in two planes,the deep plane with absorbable suture (vicryl 2.0) and the superficial plan with non absorbable suture (Nylon 2.0) ( Fig. 3 ) and the wound covered with a dried cotton dressing. The post-operative follow-up was done on an outpatient basis. She was put on amoxicillin 1 gram 3 times per day for 7 days and paracetamol 1 gram 2 times per day for 2 days. On the 10th day post incision, the sutures were removed with good wound healing, proper closure, any signs of complications like infection,swelling, pain, or discharge. ( Fig. 5 ) . The Hopkins Symptom Checklist-25(HSCL-25)was administered to the patient on the day 10th to measure symptoms of anxiety and depression and screened negative for depression and positive for anxiety yet the patient had no previous history of mental disorders (For Depression :24/15 = 1,6 1.75 cut-off ).Psycho-education was administered to the patient about the condition and the prognosis. The patient was reviewed after 3 and 12 moths ,screened negative for Anxiety and Depression using the same instrument (HSCL-25).They were no excessive scarring, such as hypertrophic scars or keloids, no any pain, discomfort, or restricted movement due to the excision site,no signs of residual nevus tissue or recurrence ( Fig. 6 , 7 ) .The patient was satisfied with the cosmetic result. The patient received psycho-education about the condition and given an appointment for review after 6 months and encourage to consult any time in case of any change of color or any symptoms occurring on the site of excision or any part of the skin on the body. Conclusion Cerebriform naevus is a rare condition that can appear not only on the scalp but also in other areas of the body. It tends to grow larger during puberty and is influenced by hormonal changes. The growth in size, changes in its appearance, and the patient's awareness of its potential for malignant transformation can impact their mental health. Complete excision, along with psychological support and regular monitoring, can help achieve the best possible outcome Declarations Acknowledgment: We acknowledge Crescent Medical Center where the patient was treated and JPC PATHOLOGY CLINIC for the pathology examination of the biopsy. Ethical Considerations The patient’s informed consent for research publication was Obtained Conflict of Interest: There is no any conflicts of interest that may influence the results or interpretations of this manuscript. References Yazici AC et al (2007) Cerebriform intradermal nevus. Pediatr Dermatol 24(2):141–143 Tagore KR, Ramineni AKS (2011) A case of cutis verticis gyrata secondary to giant cerebriform intradermal nevus. Indian J Pathol Microbiol 54(3):624–625 Tabata H, Yamakage A, Yamazaki S (1995) Cerebriform intradermal nevus. Int J Dermatol 34(9):634–634 Phiske M (2014) Cerebriform intradermal nevus: A rare entity and its associations. Indian Dermatology Online J 5(2):115–116 Mishra K et al (2017) Cerebriform nevus. BMJ Case Rep, 2017 KIM J-E et al (2010) Intradermal Nevus on the Lower Lip. Korean J Dermatology, : p. 646–648 Hayashi Y et al (2009) Malignant melanoma derived from cerebriform intradermal naevus. Clin Exp Dermatol 34(8):e840–e842 Sahni K et al (2016) Giant cerebriform intradermal nevus in a young girl. Indian Dermatol Online J 7(5):443–444 González JA et al (2010) Cerebriform intradermal nevus presenting as secondary cutis verticis gyrata. Dermatol Online J, 16(12) Jeanfils S, Tennstedt D, Lachapelle J-M (1993) Cerebriform intradermal nevus: a clinical pattern resembling cutis verticis gyrata. Dermatology 186(4):294–297 Jeanfils S, Tennstedt D, Lachapelle JM (1993) Cerebriform intradermal nevus. A clinical pattern resembling cutis verticis gyrata. Dermatology 186(4):294–297 Lasser AE (1983) Cerebriform intradermal nevus. Pediatr Dermatol 1(1):42–44 Zeng W, Guo L (2021) A rare cutis verticis gyrata secondary to cerebriform intradermal nevus: case report and literature review. BMC Surg 21(1):234 Attama C et al (2015) Psychiatric morbidity among subjects with leprosy and albinism in South East Nigeria: A comparative study. Annals Med Health Sci Res 5(3):197–204 Buljan D et al (2008) Basic aspects of psychodermatology. Psychiatria Danubina 20(3):415–418 Additional Declarations The authors declare no competing interests. Supplementary Files Document5250104154123.pdf Inform consent HOPSIKINSSYMPTOMCHECKLISTFORDEPRESSIONANDANX250104154013.pdf tool for assessment of depression and anxiety JB15923cerebriformintradermalnevus81231250104154227.pdf Result of pathology exam Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5765376","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":397730882,"identity":"97e321a9-bd66-4bc6-aed4-d835668c57da","order_by":0,"name":"INENA WA INENA Gaylord","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIiWNgGAWjYHACxgMMDMw8YOYHIGZjJ0IPXAvjDJAWZiK1gBkQjYS0yLufMTjwcY+1jDl778HPNr+2yfMxMzB++JiDW4vhmRyDgzOepfNY9pxLls7tu23YxszALDlzGx4tDTkGh3kOHOYxuJFjIJ3bc5sRqIWNmReflv43UC333xj/tuy5bU9Qi7wE3BYeM2mGH7cTCWoxkHhWcHDGgXQegzM5Zpa9DbeT25gZm/H6Rb4/eeODDwes7Q2OnzG+8ePPbdv57c0HP3zEZ8sBDgMEj7ENTDbgVg+ypYH9ARL3D17Fo2AUjIJRMEIBAPFuU95lSR5qAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0001-5297-8578","institution":"Kampala International University , Kampala,Uganda","correspondingAuthor":true,"prefix":"","firstName":"INENA","middleName":"WA INENA","lastName":"Gaylord","suffix":""}],"badges":[],"createdAt":"2025-01-04 22:04:10","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-5765376/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5765376/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":73199638,"identity":"0899519e-454d-4688-ada0-20f5b1c77e71","added_by":"auto","created_at":"2025-01-07 16:05:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":400848,"visible":true,"origin":"","legend":"\u003cp\u003eAsymmetric, skin hyperpigmented tumor with cerebriform morphological characteristics on the skin of the left flank\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-5765376/v1/7d0b014473525503abd2857e.png"},{"id":73199636,"identity":"9be72913-5b54-4ac8-9dd2-00f7a5eb2380","added_by":"auto","created_at":"2025-01-07 16:05:22","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":372252,"visible":true,"origin":"","legend":"\u003cp\u003eExcised tumor after operation\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-5765376/v1/5aa1564f71f0c9f9dac461a5.png"},{"id":73201001,"identity":"dd6106bd-0dd8-472f-b157-0b22704288f3","added_by":"auto","created_at":"2025-01-07 16:13:22","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":858735,"visible":true,"origin":"","legend":"\u003cp\u003eSuture with Nylon 2.0 after excision of the tumor\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-5765376/v1/ad69e0647814d722cf41dad3.png"},{"id":73199642,"identity":"1be708e9-6742-4131-8a6e-8190c0d00126","added_by":"auto","created_at":"2025-01-07 16:05:22","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1347659,"visible":true,"origin":"","legend":"\u003cp\u003eAnatomopathological aspect of the lesion\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-5765376/v1/a373db779bf452bb3f56a9ab.png"},{"id":73201009,"identity":"2c67e733-6779-4ce8-9a00-1a8b9c37b67b","added_by":"auto","created_at":"2025-01-07 16:13:23","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":1150398,"visible":true,"origin":"","legend":"\u003cp\u003e10 days later; Sutures removal\u003c/p\u003e","description":"","filename":"image5.png","url":"https://assets-eu.researchsquare.com/files/rs-5765376/v1/c5d61118c9d3d0376ab792f9.png"},{"id":73199648,"identity":"fa227d94-522c-4a3d-a34a-6d28039a88df","added_by":"auto","created_at":"2025-01-07 16:05:22","extension":"jpeg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":25758,"visible":true,"origin":"","legend":"\u003cp\u003eFollow-up\u003cstrong\u003e \u003c/strong\u003e3months later\u003c/p\u003e","description":"","filename":"image6.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5765376/v1/02451c211fa9f79ab79773a3.jpeg"},{"id":73200999,"identity":"b81be772-2ad2-4309-a51c-d712b6fd4d16","added_by":"auto","created_at":"2025-01-07 16:13:22","extension":"jpeg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":57458,"visible":true,"origin":"","legend":"\u003cp\u003efollow-up 12 months later\u003c/p\u003e","description":"","filename":"image7.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5765376/v1/3fc984e48d6bc6fc6908b486.jpeg"},{"id":73201413,"identity":"7ed18dae-c486-40fc-85cd-2fba59bfcea3","added_by":"auto","created_at":"2025-01-07 16:21:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5339394,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5765376/v1/43ef785a-0d6f-4b78-ad5b-7bb4597b6920.pdf"},{"id":73199637,"identity":"6e4a6cb9-e5ee-4659-b300-c51d14d5f21b","added_by":"auto","created_at":"2025-01-07 16:05:22","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":571752,"visible":true,"origin":"","legend":"\u003cp\u003eInform consent\u003c/p\u003e","description":"","filename":"Document5250104154123.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5765376/v1/0f5f349f0fc85abe7d8e2789.pdf"},{"id":73201003,"identity":"ec6f09aa-c9da-4954-8c4a-39efce0a5dcc","added_by":"auto","created_at":"2025-01-07 16:13:22","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":1439815,"visible":true,"origin":"","legend":"\u003cp\u003etool for assessment of depression and anxiety\u003c/p\u003e","description":"","filename":"HOPSIKINSSYMPTOMCHECKLISTFORDEPRESSIONANDANX250104154013.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5765376/v1/84a4b60c2c09cad4206575fd.pdf"},{"id":73199651,"identity":"93f86f42-bda5-4d4d-8129-8578f4760b43","added_by":"auto","created_at":"2025-01-07 16:05:22","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":116465,"visible":true,"origin":"","legend":"\u003cp\u003eResult of pathology exam\u003c/p\u003e","description":"","filename":"JB15923cerebriformintradermalnevus81231250104154227.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5765376/v1/6ff8ad50c88746fd8a6dc96f.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eAbdominal cerebriform intradermal nevus in a 22 years old female in the Eastern Region of Democratic Republic of Congo, A psychodermatological case report\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCerebriform intradermal nevi are a rare subtype of intradermal melanocytic nevi, characterized by their distinctive surface morphology resembling the gyri and sulci of the human brain[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These nevi typically present as benign, non-cancerous skin lesions and are classified within the broader category of melanocytic nevi, which result from the proliferation of melanocytes in the dermis[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCerebriform intradermal nevi predominantly occur as congenital lesions, often present at birth or arising in early childhood[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].Regarding sex predilection, women are more affected than males [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe cerebriform appearance is due to an exaggerated surface architecture, often caused by the hypertrophy of the dermal components[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. These nevi are generally asymptomatic, although their unusual texture and appearance may draw attention and prompt medical evaluation[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].They can vary in size and pigmentation, often appearing as raised, soft, or firm lesions with a flesh-colored, brown, or darker hue[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCerebriform intradermal naevus are most commonly observed on the scalp or face but rarely may occur in other locations[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. While they are benign, their unique morphology can occasionally mimic malignant conditions, necessitating careful clinical assessment to rule out malignancy[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eClinically it presents as asymmetric, skin‑colored or slightly pigmented tumor usually localized commonly over the scalp and rarely on the trunk and lower limb[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Over the years, it slowly enlarges and becomes more prominent and well demarcated with a cerebriform surface. Its size varies from 2 \u0026times; 3 cm to 25 \u0026times; 22.5 cm, and at times affects one half to three quarters of the scalp. Progressive alopecia is common, with hair being particularly sparse over the convolutions, and tufts emerging from the sulci. Patients may also have pruritus, tenderness, burning, recurrent infection, bleeding and a fetid and or musty odor[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese nevi are typically static or slow-growing.Pregnancy, hysterectomy, surgical exploration, and hormonal activity may induce a growth spurt of CIN[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. It is suggested that increased hormonal activity may potentiate the growth of these lesions, as growth spurt is often noted at puberty[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEarly diagnosis and treatment of CIN is important as the risk of development of malignant melanoma is high[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The life‑time incidence of melanoma arising in a giant nevus or in smaller nevi is 6.3% and 12%[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The melanoma may be present at birth, or it may arise in infancy or later in life. The mortality of such lesions is high[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDiagnosis is typically clinical, supplemented by dermoscopy, and in uncertain cases, histopathological examination is performed. Histological examination shows intradermal nevus cells present in the full thickness of the dermis which can be well delineated or irregular. Nevus cells contain varying amounts of melanin. Neuroid transformation can be present in the deeper parts of the lesion with increased collagen fibers simulating those observed in neurofibroma.The nests and nevus cells are observed merging with the neuroid tissue. Hair follicles may appear atrophied, with nevoid tissue densely abutting them[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThey may require treatment only for cosmetic reasons, irritation, or suspicion of malignancy. Options include surgical excision and plastic reconstruction ,sometimes involving tissue expansion techniques. or laser therapy, depending on the size, location, and patient preference, In cases where excision is not possible, close follow‑up of the lesion is mandatory[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough studies have not described cases of cerebriform intradermal nevi associated with mental disorders, a link has been established between disfiguring skin conditions and certain mental disorders, such as depression[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Many individuals associate unusual or irregular skin lesions with melanoma due to widespread awareness campaigns. The dramatic appearance of cerebriform intradermal nevi may amplify this fear.Patients might experience anxiety, insomnia, or even depression while awaiting diagnostic clarification. Persistent fear of recurrence or malignancy may linger even after a benign diagnosis.\u003c/p\u003e \u003cp\u003eUnderstanding the characteristics and management of cerebriform intradermal nevus is essential for clinicians to distinguish early these benign lesions from potentially harmful dermatological conditions[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].This helps to calm and reassure patients with these lesions and to avoid unnecessary excisions.\u003c/p\u003e \u003cp\u003eThis case report aims to present not only a typical case of intradermal cerebriform nevus with a particular location and good evolution after excision which confirms the existing literature in the field, but also the psychological impact of this skin conditions and the effectiveness of biopsychological approach in the management of patients with skin conditions[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e"},{"header":"Description of the case","content":"\u003cp\u003eA 21-year-old female, from BENI(KIVU) ,married ,with 2 children (the last born is 3 months old,female) presented with complaints of a black mass on the skin of her left flank. The patient also complained of a feeling of permanent fear, anxiety, and insomnia during the last 4 weeks due to the postpartum increase in the size of the mass because the lesion was first noticed at birth and gradually increased in size with age and more after the birth of her second male child.She reported no family history of skin disorders.\u003c/p\u003e \u003cp\u003eOn examination,an ovoid nodule with a long oblique axis (5x3 cm), rough to the touch, well demarcated in relation to the surrounding healthy skin, irregular edges in some areas. The surface was irregular with convolutions and depressions, the area was hairless upon inspection, no itching or painful sensation,no fetid odor \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e and no other dermatological lesions in others part of the body.The patient had a preserved general condition, without any significant founding in examination of other systems.\u003c/p\u003e \u003cp\u003eThe Hopkins Symptom Checklist-25(HSCL-25)was administered to the patient to measure symptoms of anxiety and depression and screened positive for depression and anxiety (For Depression :32/15\u0026thinsp;=\u0026thinsp;2,13\u0026thinsp;\u0026gt;\u0026thinsp;1.75 cut-off ; For Anxiety 21/10\u0026thinsp;=\u0026thinsp;2.10\u0026thinsp;\u0026gt;\u0026thinsp;1.75 cut-off ).\u003c/p\u003e \u003cp\u003ePsycho-education about the condition was administered to the patient and the care taker and to allow them to understand the procedure and the good prognosis of the condition and a written informed consent was obtained from the patient\u003c/p\u003e \u003cp\u003eA total excisional biopsy of the nodule by taking over 2 cm of healthy skin beyond the nodule and in depth \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e on local anesthesia (lidocaine 2% plus 1mg of adrenaline) showed a cerebriform mass lined by benign keratinizing squamous epithelium. The underlying dermis was diffusely infiltrated by Type A melanocytes (epithelioid large with distinct cell borders and melanin pigment) in superficial dermis and Type B melanocytes 9 smaller with less pigment) in the intermediate dermis. No mitoses, necrosis or marked atypia seen. These features were suggestive of a cerebriform intradermal naevus \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. The wound was sutured in two planes,the deep plane with absorbable suture (vicryl 2.0) and the superficial plan with non absorbable suture (Nylon 2.0) \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e and the wound covered with a dried cotton dressing.\u003c/p\u003e \u003cp\u003eThe post-operative follow-up was done on an outpatient basis. She was put on amoxicillin 1 gram 3 times per day for 7 days and paracetamol 1 gram 2 times per day for 2 days. On the 10th day post incision, the sutures were removed with good wound healing, proper closure, any signs of complications like infection,swelling, pain, or discharge.\u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eThe Hopkins Symptom Checklist-25(HSCL-25)was administered to the patient on the day 10th to measure symptoms of anxiety and depression and screened negative for depression and positive for anxiety yet the patient had no previous history of mental disorders (For Depression :24/15\u0026thinsp;=\u0026thinsp;1,6\u0026thinsp;\u0026lt;\u0026thinsp;1.75 cut-off ; For Anxiety 18/10\u0026thinsp;=\u0026thinsp;1.8\u0026thinsp;\u0026gt;\u0026thinsp;1.75 cut-off ).Psycho-education was administered to the patient about the condition and the prognosis.\u003c/p\u003e \u003cp\u003eThe patient was reviewed after 3 and 12 moths ,screened negative for Anxiety and Depression using the same instrument (HSCL-25).They were no excessive scarring, such as hypertrophic scars or keloids, no any pain, discomfort, or restricted movement due to the excision site,no signs of residual nevus tissue or recurrence\u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e,\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.The patient was satisfied with the cosmetic result.\u003c/p\u003e \u003cp\u003eThe patient received psycho-education about the condition and given an appointment for review after 6 months and encourage to consult any time in case of any change of color or any symptoms occurring on the site of excision or any part of the skin on the body.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCerebriform naevus is a rare condition that can appear not only on the scalp but also in other areas of the body. It tends to grow larger during puberty and is influenced by hormonal changes. The growth in size, changes in its appearance, and the patient's awareness of its potential for malignant transformation can impact their mental health. Complete excision, along with psychological support and regular monitoring, can help achieve the best possible outcome\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge Crescent Medical Center where the patient was treated \u0026nbsp;and JPC PATHOLOGY CLINIC for the \u0026nbsp;pathology examination of the biopsy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient\u0026rsquo;s informed consent \u0026nbsp;for research publication was Obtained\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no any conflicts of interest that may influence the results or interpretations of this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eYazici AC et al (2007) Cerebriform intradermal nevus. Pediatr Dermatol 24(2):141\u0026ndash;143\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTagore KR, Ramineni AKS (2011) A case of cutis verticis gyrata secondary to giant cerebriform intradermal nevus. Indian J Pathol Microbiol 54(3):624\u0026ndash;625\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTabata H, Yamakage A, Yamazaki S (1995) Cerebriform intradermal nevus. Int J Dermatol 34(9):634\u0026ndash;634\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhiske M (2014) Cerebriform intradermal nevus: A rare entity and its associations. Indian Dermatology Online J 5(2):115\u0026ndash;116\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMishra K et al (2017) \u003cem\u003eCerebriform nevus.\u003c/em\u003e BMJ Case Rep, 2017\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKIM J-E et al (2010) Intradermal Nevus on the Lower Lip. Korean J Dermatology, : p. 646\u0026ndash;648\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHayashi Y et al (2009) Malignant melanoma derived from cerebriform intradermal naevus. Clin Exp Dermatol 34(8):e840\u0026ndash;e842\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSahni K et al (2016) Giant cerebriform intradermal nevus in a young girl. Indian Dermatol Online J 7(5):443\u0026ndash;444\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGonz\u0026aacute;lez JA et al (2010) Cerebriform intradermal nevus presenting as secondary cutis verticis gyrata. Dermatol Online J, 16(12)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJeanfils S, Tennstedt D, Lachapelle J-M (1993) Cerebriform intradermal nevus: a clinical pattern resembling cutis verticis gyrata. Dermatology 186(4):294\u0026ndash;297\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJeanfils S, Tennstedt D, Lachapelle JM (1993) Cerebriform intradermal nevus. A clinical pattern resembling cutis verticis gyrata. Dermatology 186(4):294\u0026ndash;297\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLasser AE (1983) Cerebriform intradermal nevus. Pediatr Dermatol 1(1):42\u0026ndash;44\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZeng W, Guo L (2021) A rare cutis verticis gyrata secondary to cerebriform intradermal nevus: case report and literature review. BMC Surg 21(1):234\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAttama C et al (2015) Psychiatric morbidity among subjects with leprosy and albinism in South East Nigeria: A comparative study. Annals Med Health Sci Res 5(3):197\u0026ndash;204\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuljan D et al (2008) Basic aspects of psychodermatology. Psychiatria Danubina 20(3):415\u0026ndash;418\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Nevus, intradermal, Cerebriform, abdominal, psychodermatology","lastPublishedDoi":"10.21203/rs.3.rs-5765376/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5765376/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eCerebriform intradermal nevi (CIN) are a rare subtype of intradermal melanocytic nevi, distinguished by their characteristic surface morphology that resembles the gyri and sulci of the human brain. Typically presenting as benign skin lesions, these nevi occur predominantly as congenital formations, often evident at birth or during early childhood.Females\u0026nbsp;are\u0026nbsp;more affected. CINs generally manifest in areas such as the scalp and face and can be mistaken for malignant conditions due to their distinctive appearance and potential for growth, which may be influenced by hormonal changes, particularly during puberty and pregnancy.\u003c/p\u003e\n\u003cp\u003eAn early diagnosis is crucial due to the associated risk of malignant melanoma, with lifetime incidence rates of melanoma in CINs ranging from 6.3% to 12%. Diagnosis is primarily clinical, supported by dermoscopy and, in uncertain cases, histopathological examination. Treatment options depend on factors such as cosmetic concerns and suspicion of malignancy, with complete excision being the most common intervention.\u003c/p\u003e\n\u003cp\u003eThis case report details a 21-year-old female patient with a cerebriform lesion on her flank, exacerbated by postpartum hormonal changes. The report highlights the psychological impact of such skin conditions, as the patient experienced anxiety and depression related to her lesion. Following a successful excisional biopsy and psycho-educational support, her mental health improved significantly. This case emphasizes the importance of recognizing the psychological implications of CINs and adopting a biopsychosocial approach to patient management to ensure optimal outcomes and patient satisfaction.\u003c/p\u003e","manuscriptTitle":"Abdominal cerebriform intradermal nevus in a 22 years old female in the Eastern Region of Democratic Republic of Congo, A psychodermatological case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-07 16:05:17","doi":"10.21203/rs.3.rs-5765376/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"539975dd-deb5-45dc-ba3c-845397de13e6","owner":[],"postedDate":"January 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":42370588,"name":"Dermatology"}],"tags":[],"updatedAt":"2025-01-07T16:05:17+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-07 16:05:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5765376","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5765376","identity":"rs-5765376","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}