The surgical burden of sebaceous naevus excision in childhood

Prophylactic excision of sebaceous naevi during childhood has been common practice due to the risk of malignant transformation into basal cell carcinoma (BCC). With incidence of BCC now recognised as 0.8%, a more conservative approach to management is being advocated. The aim of this study was to evaluate the surgical burden produced by the traditional approach of prophylactic excision in childhood.

A retrospective analysis of all sebaceous naevi excised in a tertiary-referral paediatric hospital between January 2007 and December 2017 was conducted.

No malignancy was identified in this consecutive series of 189 patients. General anaesthetic was required in 99% of cases with 23% (n = 43) requiring more than one general anaesthetic. Staged-excision was performed in 17% (n = 33), with tissue expanders used in 2% (n = 3) and rotation flap in 1.6% (n = 3). Post-operative sequelae requiring re-operative intervention occurred in 7% (n = 13).

Routine excision of sebaceous naevi during childhood carries a high burden of care and is not necessary for cancer prevention. Excision can be safely delayed until patients are old enough to participate in decision-making about their surgery.