Multiple superficial lipomatous nevi coexisting with a verrucous nevus: a case report

Nevus lipomatosus cutaneous superficialis (NLCS) is a rare benign hamartoma characterized by ectopic mature adipocytes within the dermis. Verrucous epidermal nevus (VEN) is a common epidermal hamartoma presenting with verrucous hyperplasia. The coexistence of these two entities in the same patient is exceedingly rare.

A 20-year-old male presented with an 8-year history of gradually enlarging, asymptomatic papules and nodules on his left lower back. Dermatological examination revealed multiple skin-colored lesions within an area of approximately 24 × 11 cm, arranged in a band-like distribution without crossing the midline. Histopathological examination of an older nodule from the waist demonstrated mature adipose tissue proliferating in lobules within the dermis, consistent with NLCS. Biopsy of a newly developed papule from the back showed epidermal papillomatous hyperplasia, hyperkeratosis, and basal layer hyperpigmentation, consistent with VEN. Based on these findings, the patient was diagnosed with coexistent NLCS and VEN. The larger lesions were surgically excised for cosmetic reasons, and the smaller ones were treated with carbon dioxide laser.

This case highlights the rare coexistence of NLCS and VEN, suggesting a possible common developmental origin, such as a mosaic phenotype affecting both mesenchymal and epidermal lineages. When encountering linear or zosteriform skin lesions, clinicians should consider the possibility of combined hamartomas and perform multiple-site biopsies to avoid underdiagnosis.