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Mosaic NRAS Q61R mutation in a child with giant congenital melanocytic naevus, epidermal naevus syndrome and hypophosphataemic rickets
Author(s) -
Ramesh R.,
Shaw N.,
Miles E. K.,
Richard B.,
Colmenero I.,
Moss C.
Publication year - 2017
Publication title -
clinical and experimental dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.587
H-Index - 78
eISSN - 1365-2230
pISSN - 0307-6938
DOI - 10.1111/ced.12969
Subject(s) - neuroblastoma ras viral oncogene homolog , dermatology , nevus , mutation , medicine , pigmentation disorder , melanosis , rickets , pathology , biology , genetics , endocrinology , cancer research , gene , vitamin d and neurology , melanoma , kras
Summary The association of hypophosphataemic rickets with verrucous epidermal naevus ( EN ) and elevated fibroblast growth factor 23 levels is known as cutaneous–skeletal hypophosphataemia syndrome ( CSHS ), and can be caused by somatic activating mutations in RAS genes. We report a unique patient with CSHS associated with giant congenital melanocytic naevus ( CMN ), neurocutaneous melanosis and EN syndrome, manifesting as facial linear sebaceous naevus, developmental delay and ocular dermoids. An activating mutation Q61R in the NRAS gene was found in affected skin and ocular tissue but not blood, implying that the disparate manifestations are due to a multilineage activating mutation (mosaic RASopathy). We speculate on the apparently rare association of CSHS with CMN compared with EN . We also report the favourable outcome of this patient at the age of 8 years after extensive neonatal curettage of the giant CMN and use of vitamin D and phosphate supplementation.