PA36 Management of nevus sebaceus among dermatologists, plastic surgeons, paediatricians and neonatologists: a questionnaire study

Abstract Nevus sebaceus is a congenital hairless plaque, typically occurring upon the face and scalp, thought to be due to a mosaic genetic abnormality. They incur a small risk of developing a secondary malignant tumour, most commonly a locally invasive basal cell carcinoma. However, the rate of such malignancies is less than had been estimated, and routine excision is no longer recommended. We aimed to understand the current management practices of Irish plastic surgeons, dermatologists, paediatricians and neonatologists treating nevus sebaceus. We emailed a 10-question survey to Irish dermatologists and plastic surgeons registered with their respective national associations. We designed a separate 10-question survey for paediatricians and neonatologists, which we distributed at the Irish National Paediatrics Conference. We received 77 responses across four specialties. Our survey for dermatologists and plastic surgeons received 56 responses: 52% (n = 29) dermatology and 48% (n = 27) plastic surgery. Of these, 38% (n = 21) indicated being ‘very confident’ in detection of nevus sebaceus, while 11% (n = 6) reported not being confident in nevus sebaceus detection. Fifteen (27%) indicated they routinely recommend excision of nevus sebaceus: 48% (n = 13) in plastic surgery and 7% (n = 2) in dermatology. Most (73%, n = 41) indicated that they do not advise routine excision. The most common indications for routine excision included potential for malignant transformation, cosmesis and functional impairment (e.g. hair loss). Of those who routinely advise excision (n = 15), 80% (n = 12) excise under their own specialty. Of participants who have excised a nevus sebaceus the most common age of patient at excision was > 18 years. The most common management approach to nevus sebaceus by dermatologists and plastic surgeons was clinical follow-up (most commonly annually), followed by discharging patients with advice to be re-referred in case of any change. Overall, 77% (n = 43) describe their practice as not having changed in the preceding 10 years. In total, 43% (n = 24) routinely provided patients’ families with an information leaflet. We also assessed the approach of paediatricians and neonatologists to nevus sebaceus via a survey. We received 21 responses (13 from paediatrics, eight from neonatology). No respondents indicated being ‘very confident’ in nevus sebaceus detection, 11 indicated being ‘quite confident’ and 10 report not being confident. In total, 29% (n = 6) reported routinely referring babies and children with nevus sebaceus to other specialities, compared with 24% (n = 5) who do not; 48% (n = 10) indicated their approach varied based on the clinical scenario. Our study highlights variance in management approaches among Irish dermatologists and plastic surgeons. We note a minority of physicians across all four specialities providing patient information leaflets (62%, n = 48). We advise a standardized approach by dermatologists and plastic surgeons to nevus sebaceus management. We suggest establishing evidence-based clinical guidelines to ensure consistent management across all specialties.