Giant hairy 'Bathing trunk' naevus with multiple congenital melanocytic naevi

Introduction

The giant congenital melanocytic naevus is an uncommon, prernalignant disorder- an extensive naevus cell naevus present at birth. The lesion is variously called bathing trunk, cape, vest, coat-sleeve or stocking naevus depending on regional distribution. [1]

We hereby report a case of hairy bathing trunk naevus covering head, neck and trunk along with multiple congenital melanocytic naevi scattered all over the body.

Case Report

A 23-day-old male infant presented with a congenital large pigmented patch, covering posterior surface of scalp, neck, upper half of back and both shoulders, extending on to neck and upper chest anteriorly [Figure - 1]. The lesion was of black colour and peripheral skin was of dark brown colour. It was covered with light brown 1-2cm. long smooth terminal hairs. It had an elevated convoluted surface bearing two nodules around the neck. There were also present smaller multiple congenital pigmented patches of varying diameters (< 1. 5cms. to>20cms. ) scattered all over the body [Figure - 1]. These were brown to black colour. Some of these were raised and covered with brown coloured smooth terminal hair.

There was no history of headache, convulsions or any mental changes.

The biopsy from the large patch revealed histopathological changes characteristic of congenital compound melanocytic naevus i. e. nests and chords of naevus cells filling dermis and extending into sub-cutaneous fat. No cellular atypic or malignant transformation was seen.

Discussion

The common site of giant congential melanocytic naevus is lower back and thigh area. [2] In our case head, neck and upper trunk were involved. The lesion involving the cervical area may be associated with leptomeningeal melanocytosis producing seizures, hydrocephalus and mental changes leading to death. In our case no such abnormalities were found. Giant hairy ′bathing trunk′ naevus causes social embarrass-ment and may undergo malignant transformation in 13. 7% of cases. [3] The treatment of choice is total excision and split-skin grafting which can prevent the eventaul development of malignant melanoma.

This condition is rare hence being presented.