My son has a small epidermal nevus. Should I worry about potential gene mutation?

Hello doctor,

You were wonderful in allaying some health anxiety over some skin issues several months ago. So, I thought I would consult with you on another question pertaining to my son. Unfortunately, a combination of my health anxiety and the big mistake of searching online has my mind imagining the worst with regard to my son. My son is 19 years old and has no diagnosed medical issues. I noticed back when he was about eight or ten years old that he had a mark resembling a cafe au lait mark on his back, in the upper shoulder area. I had always asked the pediatrician to look at it during his yearly physicals, and they made nothing of it. Throughout the years it has grown a bit and has become darker and more rough in texture. It is probably slightly less than an inch in length and looks like a few small lesions grouped together. Again, I have brought it to the pediatrician's attention and he was not concerned. Three months ago, I made an appointment for him and my other son with a dermatologist for a skin exam, and I pointed out the spots which I wanted to be checked in particular. We met with the physician's assistant there, and my younger son had a peculiar spot I pointed out, of which the PA conducted a shave biopsy, which came back as a mildly atypical junctional nevus. For my older son, I pointed out the spot on his back/shoulder, and the PA diagnosed it as a linear epidermal nevus. She said the chances of it becoming dangerous are slim to none. It may darken throughout the years, and they will simply monitor it at yearly visits. Unfortunately, I went on to research online about epidermal nevi and of course, I ran into information showing a possible link to epidermal nevus syndrome and all of its associated neurological and skeletal defects. As I said, he is 19 and has no medical issues, is extremely intelligent, etc. In your opinion, is it safe to say that I should not be concerned about those syndromes? I presume it is primarily related to the numerous and systemic epidermal nevi, which he does not have, and I would think it would have presented by now. And my last even more neurotic question. My online research led me to some information saying that a certain type of epidermal nevus could be related to a gene mutation that could be passed along to an offspring, with them having possible serious skin scaling conditions, etc. Again, he has just one solitary small epidermal nevus. No biopsy was done, as the PA did not feel it was necessary. Do you feel there is any need for me to worry about that potential genetic mutation? Thank you so much for reading my long query.

Hello doctor,

I cannot thank you enough for your reassuring answer.

You have truly been a godsend in putting my mind at ease. Researching these medical conditions online has certainly been my downfall and has led me to these rare and obscure diseases. After this latest episode, I clearly must resist the temptation to do so. Again, my son's one linear epidermal nevus is a bit smaller than an inch, and I would say I first noticed it when he was about ten. So, I presume it is just the sporadic and limited form of it. I realize we cannot control genetics, but the reference I saw to an epidermal nevus indicating a gene mutation that can cause a severe type of skin scaling condition in their offspring scares me. Should I think that may possibly pertain to people with extensive and body-wide epidermal nevi? I am sorry to bother you with these crazy questions. But, do you feel I can rest easy and get these thoughts of gene mutations to his offspring out of my mind? Thank you again, doctor. You are truly an angel.