Ulcerating Tumor of the Scalp: Challenge

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An 85-year-old white man with a 20-year history of multiple large nodules and tumors of the scalp presented for inflammation, growth, and ulceration of a long-standing tumor. His family history was noncontributory. Physical examination showed numerous red to violaceous nodules involving the majority of the scalp with a deep-seated red nodule of the glabella and a tumor of the right parietal scalp with ulceration (Figs. 1A–C).
Skin biopsies of the scalp and glabella were done and demonstrated, respectively: small irregularly shaped islands of basaloid cells surrounded by a thin band of hyaline material and arranged in a “jigsaw” pattern (Fig. 2A); and small basaloid cells with hyperchromatic nuclei and large basaloid cells with a pale nucleus and eosinophilic globules (Fig. 2B). A biopsy of the ulcerating tumor revealed large nodules of pleomorphic cells with increased mitoses and central necrosis (Figs. 3A–C).
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