Congenital melanocytic nevus studded with strawberry haemangioma on the scalp

Introduction

Congenital melanocytic nevus, which is formed by a combination of epidermally and dermally derived nevus cells are present at birth often large and containing terminal hair. Strawberry haemangioma is a proliferative tumour of blood vessels that arises in early infancy. We often come across CMN and strawberry haemangioma separately at different sites of body To the best of our knowledge CMN studded with strawberry haemangioma presenting in a same patient is rare and hence reported.

Case Report

A six-month -old, full--term, nor-mally deliv-ered healthy male infant was brought by his mother for the evalua-tion of small CMN (black hairy nevus; with a singlered coloured strawberry haemangioma over the nevus on the right side of frontoparietal region of scalp since birth. Although both lesions were small at birth yet they were growing in size gradually for the last six months. There was no history of consanguineous marriage. No other siblings have similar lesions in the family.

On examination, well defined, darkly pig-mented patch was present covering right side of scalp extending from occiput to just beyond fron-tal hairline. Skin texture showed papillomatous thick-ening in the centre and speckled colouring at pe-riphery of nevus. Dense black terminal hairs were present on the patch. Over this nevus in the fron-toparietal region, a sharply circumscribed, round, soft, domed, red coloured swelling of size 2.5-3 cm2 in diameter was present. The surface of the lesion was lobulated. At places margins of the haemangioma showed overlying papillomatous ex-tensions. [Figure - 1] No small pigmented lesions were present on other parts of body. Systemic exami-nation did not reveal any significant organomegaly or involvement of other organs. There were no other constitutional symptoms. There was no his-tory of any infection and bleeding from the le-sions.

Discussion

CMN is present in one percent of all newborns.[3] The exact etiology of CMN is unknown. Presumably, they represent a significant defect in migration of melanocytes from the neural crest. National Institute of Health consensus conference in 1984 classified CMN into three types. Small < 1.5 cm, medium 1.5- 20 cm and giant> 20 cm. This case fits into the intermediate variety of CMN. Strawberry haemangioma is a superficial infantile haemangioma which may occur at any site but about 60% occurs on head and neck. The initial lesion is often visible on the first day of life. It is not infrequently complicated by bleeding and ulceration.[2] As the age advances, virtually all haemangiomas undergo spontaneous reggression in size which is complete or almost complete in about 95% of patients.[4] Very rarely both may undergo malignant transformation. CMN has been associated with neurofibromatosis, neurocutaneous melanosis and a variety of other defects. Unless symptomatic due to malignant transformation or bleeding from haemangioma they should best be left alone except for cosmetic purpose.

Best policy in both these conditions should be "wait and watch".