Presenter: Mounir Wassef, D.O.

Dermatology Program: Columbia Hospital, West Palm Beach (PBCGME)

Program Director: Robin Shecter, D.O.

Submitted on: July 5, 2012

CHIEF COMPLAINT:  Tender scalp lesion x 3 weeks

CLINICAL HISTORY:  64-year old woman with history of hemochromatosis presented with a tender scalp lesion x 3 weeks. She complained of hair loss and tenderness. No prior treatments. 

PHYSICAL EXAM:
There was a 2 cm x 1.5 cm erythematous plaque devoid of hair with central ulceration on the right occipital scalp.

LABORATORY TESTS: N/A

DERMATOHISTOPATHOLOGY:

In the dermis, there is an atypical glandular neoplasm (H & E, x 100)

Immunohistochemical studies are strongly positive for CK-7 in the neoplasm (x100)

DIFFERENTIAL DIAGNOSIS:

1.   Merkel Cell Carcinoma
2.   Metastatic Breast Adenocarcinoma
3.   Metastatic Colon Adenocarcinoma
4.   Metastatic Renal Cell carcinoma
5.   Nodular Basal Cell Carcinoma