Giant congenital cellular blue nevus of the scalp: neonatal presentation and approach

Martine Debyser¹, Sofie De Schepper², James D'haese¹, Veerle De Ketelaere³, Luc Cornette<sup>1

1</sup>Neonatal Intensive Care Unit AZ St Jan Bruges-Ostend AV, Bruges, Belgium; ²Department of Dermatology, Ghent University Hospital, Ghent, Belgium; ³Department of Paediatrics, St Rembert Hospital, Torhout, Belgium

Abstract: The authors report the case of a massive vaginal bleeding during labor and delivery, resulting in the birth of a newborn infant in hypovolemic shock. The origin of the bleeding was a giant congenital cellular blue nevus (CBN) of the scalp. The report illustrates the crucial role of immediate and aggressive volume resuscitation, suturing of the skin dehiscence, and firm external compression. This therapy was combined with whole-body hypothermia. The neurological outcome of the patient was normal. A shiny blue mass on the scalp should alert neonatologists to the possibility of a blue nevus of the scalp, rather than a simple scalp hematoma. Final diagnosis is made by biopsy and histologic examination. Early surgical intervention is necessary to prevent malignant degeneration and metastasis. A multidisciplinary approach involving a pediatrician/neonatologist, dermatologist, and surgeon is thus needed for diagnosis, treatment, and long-term follow-up.

Keywords: neonate, cellular blue nevus, giant blue nevus, giant congenital blue nevus, hemorrhagic shock, whole-body hypothermia