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JAMA Dermatology Clinicopathological Challenge
August 2013

Rapidly Enlarging Nodule on the Scalp

Author Affiliations
  • 1A. T. Still University, Kirksville College of Osteopathic Medicine, Kirksville, Missouri
  • 2Allergy and Dermatology Specialists, Glendale, Arizona
JAMA Dermatol. 2013;149(8):971-972. doi:10.1001/jamadermatol.2013.67a

A 72-year-old white man presented with a 1-month history of a rapidly enlarging growth of the left frontal scalp. The lesion was nontender, and the patient denied any other signs or symptoms. The patient had a history of chronic solar damage and actinic keratoses but no cutaneous malignant lesions. His medical history included diverticulosis, dyslipidemia, and superficial venous thrombosis. He had a 43–pack-year history of cigarette smoking. Baseline laboratory findings included a hemogram, notable for a white blood cell count of 3100/μL (reference range, 4000/µL-11 000/µL), an absolute neutrophil count of 7000/µL (reference range, 16 000/µL-93 000 µL), and enlarged platelets. (To convert white blood cell count and neutrophil count to ×109/L, multiply by 0.001.) Results from serum chemical analysis, liver functions, and lactic dehydrogenase level were normal. Physical examination revealed a healthy-appearing man with a solitary 3.0 × 3.5 cm nodule with mild erythema and a superficial excoriation (Figure 1). There was no adenopathy of the head or neck. A punch biopsy specimen was obtained (Figure 2 and Figure 3).