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Case 173: Scalp Lesion

This lady says that she hit her head and the wound failed to heal. When asked how long ago that injury was her family think it may have been 6 months ago. They say that they have noticed a lesion there that has slowly grown bigger with time.

1. If you took a small punch biopsy of the edge of this lesion what do you think it may show?

Most likely - Basal Cell Carcinoma, next Squamous cell carcinoma, amelanotic melanoma is also a possibility. Then possibly granulation tissue (if biopsy not accurate, foreign body reaction or mycobacterium infection)

2. The lesion feels to be fixed to the underlying pericranium. Now what are the options?

This is the classical 'rodent ulcer' of a locally invasive BCC. Excision will need to involve at least the pericranium, the outer table of the skull, or more depending on its level of invasion.

dermnetnz.org - basal-cell-carcinoma