Photo Rounds

Changing growth on scalp

A 16-year-old girl presented to her family physician (FP) for a changing growth on her scalp. She said the growth had been there for 3 months and that it sometimes bled, so she was careful when brushing her hair. She said it wasn’t painful, but she was worried that it might be skin cancer. Her mother indicated that there had been a rough patch of skin on her daughter’s scalp since early childhood. However, this growth was new, and the bleeding worried them. There was no family history of skin cancer.

What’s your diagnosis?


Changing growth on scalp

The FP thought the flat lesion (arrow) might be a nevus sebaceous (NS) and that the new area could be a malignant transformation.

The FP explained that a biopsy would be needed to learn more about the lesion. He explained that he would remove the area that was friable and bleeding along with part of the original flat lesion. After injecting the area with 1% lidocaine and epinephrine, a shave biopsy was performed using a DermaBlade. (See the Watch & Learn video on “Shave biopsy.”) The bleeding was stopped using aluminum chloride in water and some electrosurgery. The pathology results revealed syringocystadenoma papilliferum growing within an NS. This benign tumor is rare, but may develop within an NS.

The FP reassured the family that there was no skin cancer. The FP also referred the patient for full removal of the NS and any remnant of the syringocystadenoma papilliferum to avoid future growth and prevent additional bleeding.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Smith M. Epidermal nevus and nevus sebaceous. In: Usatine R, Smith M, Mayeaux EJ, et al. Color Atlas of Family Medicine, 2nd ed. New York, NY: McGraw-Hill; 2013:958-962.

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