Case Number : Case 1976 - 28 Dec 2017 Posted By: Uma Sundram

After 4 hours I'd normally have expected a few responses unless the seasions cheer has befuddled a few people. I am somewhat befuddled myself by this case. How about MHotS.

Burnt out scarring alopecia. No sebaceous glands, not much of inflammation. Collagen appears thickened and hyalinized but epidermis is not suggestive of morphea.

The history is a scalp lesion. Is it a lesion or alopecia?

I see vessels and multinucleated giant cells. If on the lower extremities, I might think of multinucleate cell angiohistiocytoma. But this is on the scalp. So need clinical history to see what we are dealing with.

What about Interstitial Granuloma Annulare?

What about herpes?

Happy New Year everyone! I think the season has affected everyone, and my apologies for this difficult case. The patient indeed had a history. Solitary lesion on the scalp, 21 year old male, with an orchiectomy specimen that came out soon thereafter. A very unusual case of metastatic choriocarcinoma. I have only seen one other case before! I admit the photographs are suboptimal, but it was not a generous biopsy. I thought one possible clue was the history (as I received this completely blinded): Young patient, solitary lesion on the scalp, always makes me think of something bad. 

Funny as a solitary lesion on the scalp at this age would have had cancer very low down! Well done Uma!