INTRODUCTION
Linear verrucous epidermal nevi (LVEN) are hamartomas
characterized by clonal proliferation of embryonic ectodermal cells in a linear configuration following Blashko's
lines.1-4,9 These sporadic, asymptomatic, female-prevalent, nonnevus cell tumors present at birth or within the first year of life
are usually localized to keratinized: facial, neck, trunk or extremity skin; rarely oral and genital lesions have been reported.5-6,10
Less common systematized forms include unilateral (nevus unis
lateralis) and extensive bilateral (ichthyosis hystrix). A subset of
tumors (<30%) may be associated with the epidermal nevus or
Solomons' syndrome-a phakomatosis that can include: ocular,
skeletal' cardiac, renal, neurologic (seizures, mental retardation)
defects as well as intracranial and/or intraspinal lipomas.2,3 Rarely, the development of squamous cell, basal cell, and other skin
carcinomas has been reported.11-17Generally, LVEN are benign;
the patients' desire for an improved appearance of the affected
area is the primary rationale for treatment.
Treatment modalities including excision, laser, dermabrasion,
cryosurgery, chemical peels, anthralin, systemic and topical
retinoids, 5-flourouarcil, calcipotriene, and podophyllin have
been limited by unacceptable cosmetic outcomes, recurrence,
or unacceptable toxicities.18-24
OBJECTIVE
The goal in this patient was to provide a permanent improvement in the clinical appearance of the site with minimal scarring,
therefore, electrosurgery was considered. We previously reported the successful treatment of refractory, intertriginous Darier's Disease using electrosurgery.25 The
discussion that follows describes the use of electroplaning (a
refined form of electrosurgery) for the removal of linear verrucous epidermal nevi from the skin of the breast and areola
in an African American female that includes 10-year followup photographs.26-29
Case Study
A healthy 23-year-old African-American nulliparous female presented requesting treatment of an asymptomatic 'embarrassing'
mole on her chest present since birth, growing as she grew.
There was no family history of similar lesions, her childhood
developmental milestones were within normal ranges, and she
denied a history of seizures or other medical problems.
On physical examination, the patient was a healthy, young
adult woman without evidence of skeletal, neurologic, ocularor auditory deficits suggestive of nevus syndrome. Her cutaneous examination was significant for mild facial acne vulgaris
and hyperpigmented verruciform, soft papillomatous papules
coalesced in linear arrays radiating from the skin of her left
breast. The skin of the left nipple was deformed by the presence
of similar lesions growing in a horn-like formation. The aperture
to the lactiferous glands was not visible. There were no underlying lesions detectable by palpation. There were no caféau lait
spots. There were no keloidal or hypertrophic scars or evidence
