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Nov 2011

Neglected Squamous Cell Carcinoma Hiding Under a Toupee

Author Affiliations

Author Affiliations: Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut (Drs Craiglow and King); and Veterans Affairs Connecticut Health Care System, West Haven, Connecticut (Dr Craiglow).

Arch Dermatol. 2011;147(11):1338-1339. doi:10.1001/archdermatol.2011.316

An 86-year-old man with a history of basal cell carcinoma was referred by his primary care physician to our dermatology clinic for a lesion of concern on the nasal bridge. On physical examination, we found a thin, pink, gritty, 2-mm papule consistent with an actinic keratosis. Knowing the patient's history of skin cancer, we also performed a full-body skin examination. The patient wore a hairpiece, under which we found a pink, lobulated, 7-cm tumor with fibrinous exudate and focal areas of ulceration (Figure). Biopsy of the lesion demonstrated squamous cell carcinoma; a computed tomographic scan showed that the mass had invaded the subcutaneous fat and abutted the frontal bone without intracranial extension. The patient subsequently underwent wide local excision with full-thickness skin grafting.