Wenfang Dong, Huan Wang, and Fei Fan
A 27-year-old woman was admitted to the hospital for evaluation of a huge black scalp macule (20 × 18 cm) with thinning of the overlying hair (Figure 1). The asymptomatic scalp macule first appeared upon her birth and gradually increased in size. On physical examination, the scalp macule was characterized by brain-like sulcus and gyrus formation, which is a typical feature of CVG, without other abnormalities. Normal results were obtained for all laboratory tests, including routine blood, urine, and stool analyses; hepatorenal function; blood glucose and lipid concentrations; and electrolyte concentrations. The patient’s medical and familial histories were unremarkable. The patient was diagnosed with secondary CVG. Because tumoral lesions are the most common cause of secondary CVG and because of the aesthetic concerns associated with the disease, surgical management was considered the optimal treatment.
We were concerned that the patient did not have enough hair-bearing tissue for scalp reconstruction after surgical excision because of the extensive scope of the lesion. Therefore, a two-stage surgery with reconstruction was finally planned. During the first stage, four rectangular inflatable tissue expanders (300-, 300-, 100-, and 80-mL) were placed under the scalp galea on both sides of the forehead and mastoid regions (Figure 2). Over a 6-month period, the expanders were inflated twice weekly until they reached a total volume of 1400, 1400, 450, and 400 mL, respectively. During the second stage, full-thickness excision of the lesion with a 0.5-cm skin margin was performed without disturbing the periosteum, and closure was achieved with rotation advancement flaps from the adjacent expanded scalp without perioperative complications (Figure 3). The patient was diagnosed with CIN according to postoperative pathological findings. During the 6-month postoperative follow-up, there was no evidence of recurrence; only a scar was present under the coverage of the hair.
Declaration of conflicting interest: The authors declare that there is no conflict of interest.
Ethical approval: All procedures involving this patient were performed in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Funding: This work was supported by the CAMS Innovation Fund for Medical Sciences (Grant No. CAMS-12M-1-007).
Informed consent: Informed consent was obtained from the patient described in this report.
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The Twelfth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaFei Fan, The Twelfth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing 100144, China. Email: nc.ude.cmup.hsp@iefnaf