Uncommon skin cancer: pleomorphic dermal sarcoma

Descriptions

An 86-year-old man presented to the dermatology clinic with a 10-week history of lesion on the vertex of his scalp. This had been intermittently crusting and bleeding but was non-tender and not enlarging. The patient had a background of two previous squamous cell skin carcinomas of his right shoulder and left ear. With regards to his sun exposure, he had previously served in the armed forces and had been posted to hot countries. On physical examination there was a 9x13 mm raised lesion with an overlying crust and rolled edges on the scalp vertex (see figure 1A,B). There was no evidence of cervical lymphadenopathy. Clinical suspicion was that of a keratoacanthoma or squamous cell carcinoma, given the patient's background. A 4 mm cutaneous punch biopsy was organised on the fast-track pathway.

Figure 1

(A, B) Close-up of the scalp lesion.

Histological...

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