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Clinical Challenge
Nov/Dec 2015

Scalp Lesion in a Man With Chronic Sun Exposure

Author Affiliations
  • 1Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
JAMA Facial Plast Surg. 2015;17(6):455-456. doi:10.1001/jamafacial.2015.1025

A man in his 70s with a history of multiple nonmelanoma skin cancers presented with a recurrent lesion on the anterior scalp. He first developed the lesion 2 years previously, at which time it was treated with liquid nitrogen followed by excision and closure. The lesion recurred 6 months later and grew slowly since that time. The patient reported that the lesion itches and bleeds spontaneously from time to time. The lesion was biopsied, revealing recurrent basal cell carcinoma with an aggressive growth pattern. He subsequently underwent Mohs micrographic surgery to excise the lesion with clear margins. Following Mohs surgery, the defect measured 8 × 7.5 cm (Figure 1). The periosteum was involved centrally and thus the outer table of the calvarium was burred. The patient is a former smoker but quit several years ago. He has a history of prostate cancer but is currently free of disease. He does have a cardiac arrhythmia but is not taking an anticoagulant and has no other major medical comorbidities.

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