Giant cerebriform intradermal nevus in a young girl

Sir, A 13-year-old girl presented with complaints of a boggy mass on her left frontoparietal scalp since birth with thinning of the overlying hair. The lesion was first noticed at birth and gradually increased in size with age. On examination, a large (12 × 14 cm) soft to firm, bosselated, skin-colored plaque was seen involving the vertex and left frontoparietal scalp. The surface was irregular with convolutions and depressions and there were prominent follicular openings with sparse overlying hair. Solitary (1 × 1 cm), erythematous, pedunculated, firm nodule was noted over the surface [Figure 1]. A punch biopsy from the plaque and an excisional biopsy of the overlying nodule, showed the presence of intradermal nevoid cells in nests with variable amounts of pigmentation. The upper dermal nevoid cells showed dense pigmentation, which was minimal in the deeper dermal nest. These features were suggestive of a cerebriform intradermal nevus [Figure 2]. These nevoid cells stained positive with HMB45 antibody on immunohistochemistry [Figure 3]. The patient was referred to the plastic surgery department for tissue expansion followed by excision.