Cerebriform nevus.

Mishra K, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-222402 Description A 38-year-old man presented with insidious onset, gradually progressive and non-painful swelling over skull since childhood. His parents gave a history of noticing a dark-coloured patch over the right side of the head at birth which increased in size and attained the present form at around puberty and has been static since then. As it was asymptomatic and covered with turban (religious), they didn’t bother about it much. Clinical examination revealed a sessile, non-tender, soft, 11×5 cm swelling over the right parieto-temporal scalp with sulci and gyri giving the characteristic ‘cerebriform’ appearance (figure 1). The rest of the clinical examination was unremarkable. The patient was informed about the benign nature of cerebriform nevus requiring close observation versus surgical excision and reconstruction in view of the possibility of malignant transformation. The patient took an informed decision of no surgical intervention. Twelve months later, the scalp swelling continued to be asymptomatic and static in size. Cerebrifrom nevus is an extremely rare hamartoma of skin usually present since birth. It usually presents as a hyperpigmented patch most commonly over the scalp, trunk and lower limb. It has a propensity to increase in size during puberty under hormonal influence and acquires multiple convolutions over the surface giving rise to characteristic ‘cerebriform’ appearance. Although a benign lesion, it has a potential of transformation into melanoma and the estimated life time risk is 6.3%–12%. Usually, it remains asymptomatic and reason of consultation is often cosmetic. Treatment favoured is wide excision followed by skin graft; however, when not feasible, close observation is recommended.