Letter to the Editor Dear Sir, We are pleased to read the article titled `Cellular blue naevus of the scalp with brain invasion' by Golden et al. 1 in September 2000. However, we would like to comment on two aspects of this case report. First, the authors referred to the case reported by Silverberg et al. 2 in 1971 as Cellular Blue Naevus (CBN) of the scalp with direct intracranial involvement. We think there are two refer- ences about the autopsy findings of the same case in later years that suggested no intracranial involvement. In 1981, Hendrickson 3 from the same hospital as Silverberg, reporting on a morphologic study of neoplasms arising in congenital giant nevi, noted that invasion of the brain parenchyma was not demonstrated at autopsy in the above case. In 1986, Prolo, 4 one of the authors of the case report by Silverberg, in his comments on the article by Marano et al., reported on the case by Silverberg that a detailed study of the brain at autopsy revealed the brain to be free of tumour. Second, to our knowledge there is at least another case of CBN of the scalp associated with local extension to the brain parenchyma. In 1987 Nakano et al. 5 reported a 6 year old boy with a congenital naevus of the right frontotemporoparietal area of the scalp with direct extension in to the base of the right middle cranial fossa and the right orbit. So, the case reported by Golden et al. would still be the second case of CBN of the scalp with direct intracranial involvement. VANI PRASAD, Research Registrar, T.J.C. EDWARDS, Senior Lecturer, RODNEY DCOOTER, Director, Dept. of Plastic & Reconstructive Surgery Royal Adelaide Hospital, North Terrace, Adelaide SA 5000, Australia REFERENCES 1. Golden N, Maliawan S, Mulyadi K. Cellular blue naevus of the scalp with brain invasion. J Clin Neurosci 2000; 7(5): 453±454. 2. Silverberg GD, Kadin ME, Dorfman RF, Hanbery JW, Prolo DJ. Invasion of the brain by cellular blue nevus of the scalp. Cancer 1971; 27: 349±355. 3. Hendrickson MR. Neoplasms arising in congenital giant nevi. American Journal of Surg Pathol 1981; 5: 109±135. 4. Marano SR, Brooks RA, Spetzler RF, Rekate HL. Giant congenital cellular blue nevus of the scalp of a newborn with an underlying skull defect and invasion of the duramater. Neurosurgery 1986; 18(1): 85±89. 5. Nakano S, Kinoshita K, Morita Y, Inoue S, Kawana N. Cellular blue Nevus of the scalp associated with intracranial involvement. Surg Neurol 1987; 27: 553±557. DOI: 10.1054/jocn.2001.1049, available online at http://www.idealibrary.com on Reply to the Letter Dear Sir, I agree that the case we reported was probably the second case ever reported after Silverberg et al. in 1971. The differences were (1) that our case was an older woman, (2) the patient came to us with signs of `space occupying process' and not because of skin pigmentation and (3) the skin pigmentation and intra- cranial mass were coincidentally discovered. There were cases of cellular blue naevi of the scalp invaded down to duramater, but without any intracranial mass or space occupying lesions. Findler et al. 1981, reported one case of giant naevus associated with intracranial pigmentation in a six year old girl. The pigmentation extended from the skin to the outer layer of duramater without intracranial mass. Menter et al. 1971, reported a congenital giant blue naevus of the scalps in two children of the Bantu tribe. The pigmentation extended from the skin into all layers of duramater without intracranial mass. Marano et al. 1986, also reported the case of a newborn baby with giant congenital cellular blue naevus extending from the skin into the duramater without intracranial mass. Dr NYOMAN GOLDEN Department of Neurosurgery, School of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia 80114 REFERENCES 1. Golden N, Maliawan S, Mulyadi K. Cellular blue naevus of the scalp with brain invasion. J Clin Neurosci 2000; 7(5): 453±454. 2. Silverberg GD, Kadin ME, Dorfman RF Hanbery JW, Prolo DJ. Invasion of the brain by cellular blue nevus of the scalp. Cancer 1971; 27: 349±355. 3. Findler G, Hoffman HJ, Thomson HG, Becker L. Giant nevus of the scalp associated with intracranial pigmentation. Case report. J Neurosurg 1981; 54: 108±112. 4. Menter MA, Griessel PJC, de Klerk DJ. Giant blue nevus of the scalp with underlying skulldefect. Br J Dermatol (Suppl) 1971; 73±75. 5. Marano SR, Brooks RA, Spetzler RF, Rekate HL. Giant congenital cellular blue nevus of the scalp of a new born with an underlying skull defect and invasion of duramater. Neurosurgey 1986; 18(1): 85±89. Journal of Clinical Neuroscience (2002) 9(2), 219 & 2002, Elsevier Science Ltd. All rights reserved. DOI: 10.1054/jocn.2001.1048, available online at http://www.idealibrary.com on 219