A 70-Year-Old Woman with a Brown Nodule on the Scalp

Abstract

Scalp basal cell carcinoma constitutes for 2.7% of all basal cell carcinomas. It is more commonly observed in men. The mean age for the development of scalp basal cell carcinoma is 66.9 ± 15.1 years. Scalp basal cell carcinomas are larger than in other sites, which may be explained by the abundant blood supply and the presence of hair masking growth of the nodule. Basal cell carcinoma presents as a tiny, hardly visible papule, growing usually for years into a nodule or a plaque, sometimes ulcerated. Basal cell carcinomas on the scalp tend to present more pigmented compared to other body sites. In histopathological examination, nodular and mixed types of basal cell carcinoma are most commonly described. The first-line treatment of basal cell carcinoma is complete surgery. Topical therapies (5% imiquimod, 5% fluorouracil) and destructive approaches (curettage, electrocautery, cryotherapy, laser ablation, photodynamic therapy) should be considered in patients with low-risk superficial malignancy. Hedgehog inhibitors, vismodegib or sonidegib, may be offered to patients with locally advanced and metastatic basal cell carcicoma.