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March 2009
By Richard Cordova, DO, and Stephen M. Schleicher, MD
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CASE:
A 67-year-old man presents for evaluation of an enlarging mid-scalp lesion. He first noticed the growth four weeks ago and states that it is asymptomatic and has not bled. The patient is fair-skinned and admits to ample sun exposure over many decades. His medical history is significant for treatment of multiple actinic keratoses as well as basal and squamous cell carcinoma. Most recently, a basal cell carcinoma on his frontal scalp was treated with radiation therapy. Physical examination reveals a dome-shaped, erythematous nodule.
WHAT IS YOUR DIAGNOSIS? |
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The patient has an atypical fibroxanthoma. These reddened, “juicy,” dome-shaped nodules grow rapidly on sun-damaged scalp, face, and neck skin, most often in elderly individuals. They are low-grade sarcomas with a very low incidence of recurrence following simple excision. Metastasis to regional lymph nodes is possible, but quite rare. Differential diagnosis includes basal and squamous cell carcinomas, pyogenic granuloma, amelanotic melanoma and metastases. |
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Dr. Cordova is a practicing dermatologist in Laurys Station, Pennsylvania. Dr. Schleicher is director of the DermDOX Center in Hazelton, Pennsylvania, a clinical instructor of dermatology at the Philadelphia College of Osteopathic Medicine and Kings College in Wilkes-Barre, Pennsylvania, and an associate professor of medicine at the Commonwealth Medical School in Scranton, Pennsylvania. He is also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 41(3):31-32, 2009
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