A 78-Year-Old Tennis Player With a Growth on His Scalp

Carl H. Manstein, MD, MBA; Samuel Max Manstein

Disclosures

July 20, 2016

Correct Answer: B. Basal cell carcinoma

Although melanoma can have many different presentations, the raised and nodular appearance of this lesion fits more into the pattern of basal cell carcinoma. Amelanotic melanomas present a diagnostic quandary, as they can masquerade as many other skin pathologies. For example, as many as 8% of all melanomas are devoid of significant pigmentation.[1]

The possibility of this being keratoacanthoma is less likely because of the history of slow growth over 6 months. Keratoacanthomas usually develop over a much shorter period and are more rapid in their onset.[2]Prostate cancer usually metastasizes to the bone. Metastatic skull tumors are not uncommon, but most are calvarial circumscribed intraosseous tumors. These tumors can spread from the skull and either outward to the scalp or inward to the dura. In a recent study of metastatic skull tumors, primary sites were breast (55%), lung (14%), and prostate (6%).[3] It is important to note that this patient's growth is not the classic appearance of a cutaneous horn.

Question 3.

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