Giant congenital melanocytic nevus with vascular malformation and epidermal cysts associated with a somatic activating mutation in BRAF

Pigment Cell Melanoma Res. 2018 May;31(3):437-441. doi: 10.1111/pcmr.12685. Epub 2018 Jan 29.


Giant congenital melanocytic nevi may be symptomatically isolated or syndromic. Associations with capillary malformations are exceptional, and development of epidermal cysts has not been described. A 71-year-old patient with a giant congenital melanocytic nevus (CMN) of the lower back, buttocks, and thighs was asymptomatic except for unexpected hemorrhage during partial surgical excision years before. Blunt trauma at age 64 initiated recurrent, severe pain under the nevus; multiple large epidermal cysts then developed within it. Imaging and biopsy showed a large, non-pulsatile venous malformation intermingled with the deep nevus. A low-abundance, heterozygous BRAF c.1799T>A (p.V600E) mutation was present in both gluteal and occipital congenital nevi; additional mutations in NRAS, GNAQ, GNA11, HRAS, or PIK3CA were undetectable. This is the first demonstration of a recurrent BRAF mutation in multiple large congenital nevi from the same individual, confirming that this malformation can have multiple genetic origins. Early constitutive activation of BRAF can therefore cause unusual associations of giant nevi with vascular malformations, indicating that both pigment and endothelial cell physiology may be affected by mosaic RASopathies.

Keywords: braf; malformation; mosaic; neural crest; venous.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Epidermal Cyst* / congenital
  • Epidermal Cyst* / enzymology
  • Epidermal Cyst* / pathology
  • Epidermal Cyst* / surgery
  • Humans
  • Male
  • Mutation*
  • Nevus, Pigmented* / congenital
  • Nevus, Pigmented* / enzymology
  • Nevus, Pigmented* / surgery
  • Proto-Oncogene Proteins B-raf / genetics*
  • Vascular Malformations* / enzymology
  • Vascular Malformations* / genetics
  • Vascular Malformations* / pathology


  • BRAF protein, human
  • Proto-Oncogene Proteins B-raf