Nevus Lipomatosus Superficialis with Mixed Morphologic Features: Gross, Sonographic, and Histopathologic Correlation

Nevus lipomatosus superficialis (NLS) is an uncommon benign hamartoma characterized by ectopic adipocytes within the dermis and may present with features that overlap clinically with other soft, pedunculated, or cerebriform lesions. We report a rare presentation with mixed morphologic traits that created diagnostic uncertainty on gross examination. The lesion demonstrated atypical surface contour and texture, prompting multimodal evaluation to clarify the differential diagnosis and support safe outpatient management. Point-of-care ultrasound (POCUS) was used to evaluate lesion architecture and vascularity. Findings provided real-time, noninvasive support for benign morphology and informed procedural planning. Subsequent histopathologic analysis established the diagnosis by demonstrating dermal adipose deposition consistent with NLS. This case underscores the value of integrating gross examination with sonographic assessment and histopathology when cutaneous lesions have overlapping clinical features. In addition, it contributes to the limited literature describing ultrasound findings in NLS. Incorporating POCUS into the assessment of atypical cutaneous growths may improve diagnostic confidence, reduce unnecessary escalation of care, and support efficient, safe treatment in outpatient settings.