What Is This Ulcerated Nodule on an Older Man’s Scalp?
A 74-year-old white man with a history of severe plaque psoriasis presented for establishment of care; incidentally, an enlarging mass was found on the right posterior scalp.
The patient stated that the lesion had been present for approximately 1 month. He explained that the lesion had been evaluated in multiple urgent care settings, and he had been told that it was a traumatic wound, and no further workup had been pursued.
Examination at the time of his first dermatology evaluation revealed a 6-cm, skin-colored and pink to erythematous, ulcerated nodule draining malodourous yellow fluid and scant blood (Figure). The patient reported localized pain and tenderness of moderate severity. As the patient tilted his head downward and toward the right, the lesion became more brightly erythematous. Periorbital edema was noted on the right side.
The patient denied any constitutional symptoms, history of skin cancer, or known occupational chemical or radiation exposure. His medical history was significant for chronic obstructive lung disease, cardiovascular disease, atrial fibrillation, diabetes mellitus with chronic renal impairment, and gastroesophageal reflux disease. He had been a previous heavy smoker.
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