A 35-year-old man presented with a 3-year history of a small, soft nodule on the hairline of his left forehead area. With time, the mass had gradually increased in size to involve most of the left side of the forehead and scalp. Physical examination revealed a large, firm, solid soft tissue mass involving the left side of the scalp and forehead, with some extension to the left orbital rim and right side of the scalp. The mass had stretched the skin with an irregular contour. An area of ulceration involved the entire superior surface, exposing the underlying tissue with necrotic and hemorrhagic areas and emitting a fibrinopurulent discharge (Figure 1). There were no cranial nerve palsies or other focal neurologic findings. The patient denied any headaches, visual or auditory impairments, memory problems, or syncope. The results of the rest of the examination were unremarkable.
Quintanilla-Dieck MDL, Farrag TY, Micchelli S, Burkart A, Aygun N, Tufano RP. Pathology Quiz Case. Arch Otolaryngol Head Neck Surg. 2008;134(8):897. doi:10.1001/archotol.134.8.897