Correspondence Address:
Nader Pazyar
Department of Dermatology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz
Iran

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Sir,

Organoid nevus or nevus sebaceous of Jadassohn is a congenital hamartoma that may differentiate more than one adnexal structure. In other words, it is a pluripotential tumour.[1] This differentiation is usually benign but sometimes malignant[2] A 34-year-old woman was admitted to evaluate an asymptomatic yellowish linear lesion on the right lower lid since childhood. She noted that the lesion is congenital, but its surface showed a raised appearance after puberty. Physical exam revealed an yellowish linear plaque with 3 × 0.5 cm diameter on the right lower lid. The lesion's surface showed a dome-shaped reddish nodule on a soft papillomatous facing [Figure 1]. The examination of another side of the body, mucosa membranes, hair and nails was normal. No Palpable lymph node on the neck or organomegaly was detected. The initial skin biopsy from the lesion reported sebaceous nevus. After surgery of the total lesion, the sample was submitted for histological study. The histopathology report revealed an organoid nevus with sebaceous adenoma, sebaceoma (sebaceous epithelioma), superficial solid basal cell carcinoma and adenoid basal cell epithelioma [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]. After 6 years of follow-up of the patient, no recurrence was seen. Nevus sebaceous (NS) is a congenital hamartoma that shows a benign proliferation of sebaceous glands, with a prevalence of 0.3% in newborns.[3],[4] Clinically, it usually presents as a yellowish smooth linear patch and without a mature hair follicle at birth. The most common site of nevus sebaceous is the scalp and face.[4] During puberty, due to androgens' effects on sebaceous and apocrine glands, it undergoes rapid growth and can become more verrucous and cerebriform.[3] The large size may be associated with eyes and neurological abnormalities.[3] Organoid nevus is a pluripotential tumour that, over time, shows both benign and malignant changes.[3] The most common benign tumour that develops secondarily within NS is syringocystadenoma papilliferum, followed by trichoblastoma, nodular hidradenoma, syringoma and trichilemmoma.[2],[5] The rate of malignant transformation within NS is low, ranging from 0% to 0.8%.[3] The most frequent malignant tumour within NS is basal cell carcinoma (BCC),[2],[5] but it is a very rare event.[2] Our case revealed a combination of benign and malignant tumours, including sebaceous adenoma, sebaceoma (sebaceous epithelioma), solid type BCC and adenoid type BCC. It appears that the occurrence of four tumours in the case of NS is a rare event. Histologically, sebaceous adenoma is a circumscribed and lobular tumour with peripheral basaloid cells and more than 50% mature sebocytes open to the skin's surface. Histologically, sebaceoma shows multiple nests of basaloid cells, with less than 50% mature sebocytes or more showing basaloid cells. Overall, the picture of histology of BCC consists of basaloid cells islands with hyperchromatic nucleus with little cytoplasm, palisading of the cells at the periphery, haphazard arrangement in the stroma of the islands and stromal retraction. Regarding the patient's age, the time of NS's surgery should be the weight of risk and benefits of general anaesthesia to local anaesthesia.[3]{Figure 1}{Figure 2}{Figure 3}{Figure 4}{Figure 5}{Figure 6}

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