Case 21 Giant Hairy Nevus
21.1 Description
Large, pigmented, hair-bearing skin lesion on the posterior trunk of an otherwise healthy-appearing child
Satellite nevi are noted
Presence at birth suggests giant congenital melanocytic nevus
21.2 Work-Up
21.2.1 History
Presence of lesion at birth or its development later
Changes in size, color, and other appearances. Has it grown proportionally with the child?
Presence of additional satellite lesions
Presence of associated conditions (e.g., spina bifida, neurofibromatosis)
Family history of congenital nevi of skin cancer
21.2.2 Physical Examination
Evaluate the focus of the lesion as well as the rest of the skin for presence of satellite lesions
Location of lesions
Cephalic or midline neck/spine lesions may be associated with neurologic conditions
May occur in bathing trunk pattern or with stocking glove distribution
Measure and document the size of the lesion
Giant hairy nevus: At least 20 cm in diameter or comprising 2% of the total body surface area
Take photos for comparison at future visits and monitoring
Assess for changes that suggest malignancy such as ulceration, bleeding, or change from prior visits
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