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Special Feature
June 7, 2010

Picture of the Month—Quiz Case

Author Affiliations



Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2010

Arch Pediatr Adolesc Med. 2010;164(6):577. doi:10.1001/archpediatrics.2010.68-a

A 9-year-old girl presented to our pediatric dermatology practice for evaluation of a congenital scalp lesion. Her new pediatrician had noted the scalp nodule on examination and subsequently referred her. Her family reported that at age 2 weeks, the nodule became erythematous and depressed. Thereafter, it gradually expanded and protruded as the patient grew. There was no history of pain, pruritus, breakdown, bleeding, or discharge from the site. The patient was delivered at full term by normal, spontaneous vaginal delivery, and she had no other significant medical history or medical symptoms. Her family history was also unremarkable.

Her physical examination revealed an approximately 1.5-cm pink, hairless nodule in the posterior midline of her scalp (Figure 1). Magnetic resonance imaging suggested the diagnosis (Figure 2and Figure 3).

Figure 1.
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Erythematous nodule measuring 1.5 cm on the posterior midline scalp of a 9-year-old girl.

Figure 2.
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A magnetic resonance image of the head revealed an enhancing nodule superficial to the skull.

Figure 3.
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A magnetic resonance image of the head further revealed a bony defect in the skull under the scalp nodule.

What is your diagnosis?