Electroplaning of Non-Inflammatory Linear Verrucous Epidermal Nevi (LVEN)
April 2012 | Volume 11 | Issue 4 | Original Article | 474 | Copyright © 2012
Background: The non-inflammatory linear verrucous subtype of epidermal nevi (LVEN) although generally benign, can be aestheti-
cally displeasing and functionally disfiguring to patients.
Objective: To provide a permanent improvement in the clinical appearance of LVEN with minimal scarring.
Method: Electroplaning with Surgitron®FFPF EMC was the chosen method of treatment.
Results: Electroplaning is a simple, safe, and effective method for improving the appearance of non-inflammatory linear epidermal nevi.
J Drugs Dermatol. 2012;11(4):474-477.
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Linear verrucous epidermal nevi (LVEN) are hamartomas characterized by clonal proliferation of embryonic ectodermal cells in a linear configuration following Blashko's lines.1-4,9 These sporadic, asymptomatic, female-prevalent, nonnevus cell tumors present at birth or within the first year of life are usually localized to keratinized: facial, neck, trunk or extremity skin; rarely oral and genital lesions have been reported.5-6,10 Less common systematized forms include unilateral (nevus unis lateralis) and extensive bilateral (ichthyosis hystrix). A subset of tumors (<30%) may be associated with the epidermal nevus or Solomons' syndrome-a phakomatosis that can include: ocular, skeletal' cardiac, renal, neurologic (seizures, mental retardation) defects as well as intracranial and/or intraspinal lipomas.2,3 Rarely, the development of squamous cell, basal cell, and other skin carcinomas has been reported.11-17Generally, LVEN are benign; the patients' desire for an improved appearance of the affected area is the primary rationale for treatment.
Treatment modalities including excision, laser, dermabrasion, cryosurgery, chemical peels, anthralin, systemic and topical retinoids, 5-flourouarcil, calcipotriene, and podophyllin have been limited by unacceptable cosmetic outcomes, recurrence, or unacceptable toxicities.18-24
The goal in this patient was to provide a permanent improvement in the clinical appearance of the site with minimal scarring, therefore, electrosurgery was considered. We previously reported the successful treatment of refractory, intertriginous Darier's Disease using electrosurgery.25 The discussion that follows describes the use of electroplaning (a refined form of electrosurgery) for the removal of linear verrucous epidermal nevi from the skin of the breast and areola in an African American female that includes 10-year followup photographs.26-29
Case StudyA healthy 23-year-old African-American nulliparous female presented requesting treatment of an asymptomatic 'embarrassing' mole on her chest present since birth, growing as she grew.
There was no family history of similar lesions, her childhood developmental milestones were within normal ranges, and she denied a history of seizures or other medical problems.
On physical examination, the patient was a healthy, young adult woman without evidence of skeletal, neurologic, ocularor auditory deficits suggestive of nevus syndrome. Her cutaneous examination was significant for mild facial acne vulgaris and hyperpigmented verruciform, soft papillomatous papules coalesced in linear arrays radiating from the skin of her left breast. The skin of the left nipple was deformed by the presence of similar lesions growing in a horn-like formation. The aperture to the lactiferous glands was not visible. There were no underlying lesions detectable by palpation. There were no caféau lait spots. There were no keloidal or hypertrophic scars or evidence