Nevus lipomatosus superficialis – Dermoscopy findings

A 22-year-old female presented with complains of an asymptomatic soft large lesion on the left upper chest present since birth. The lesion first started as a skin colored soft swelling in the right upper chest and within a period of 6 months new similar lesions appeared and they enlarged gradually to attain the present size. There was no history of ulceration or bleeding. On examination, there were multiple discrete and confluent soft non-cystic skin colored to slightly yellowish plaques with areas of pigmentation extending from the left upper anterior shoulder to the lateral pectoral region and anterior axillary fold, with the lower inferior region showing cobble stoning [Figure 1a]. Dermoscopy under non-polarized light showed yellowish areas with reticulate pigmentary network [Figure 1b]. Dermoscopy under polarizing light showed sulci and gyri with cerebriform appearance [Figure 1c]. Skin biopsy showed the entire dermis packed with adipocytes and dilated blood vessels [Figure 1d]. We made a final diagnosis of nevus lipomatosus superficialis (NLS). Plastic surgery department is planning for excision. NLS is a hamartoma of fatty tissue.^[1] They exhibit ectopic areas of fat deposition in the papillary and reticular dermis. They may be solitary of multiple, the lower abdomen and buttocks being the commonest sites. They classically present with skin colored to yellowish nodules and plaques with cerebriform appearance.^[2] However, this appearance was not seen in our patient, but dermoscopy showed cerebriform appearance. NLS is benign lesions and malignant transformation has not reported so far.^[3] They may also be seen in Michelin tire baby syndrome and HITCH syndrome (H-hearing impaired, T-undescended testes, C-circumficial skin folds, and H-mental handicap).

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Figure 1:

(a) Soft skin colored to yellowish plaques on the left upper shoulder and chest with inferior area (arrow) showing cobble stoning. (b) Dermoscopy showing yellowish areas (black arrow) with reticulate pigmentary network (white arrow), non-polarizing ×40. (c) Dermoscopy showing sulci and gyri with cerebriform appearance (white arrow), polarizing ×80. (d) Skin biopsy showing the dermis packed with adipocytes (white arrow) and blood vessels, Hematoxylin and Eosin ×400.

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