What Is This Rapidly Growing Scalp Lesion on a 7-Year-Old?

AUTHORS:
Brittney M. Knudson, PA-C¹ • Pisepong Patamasucon, MD² • Sarah W. Lai, MD MSc¹

AFFILIATIONS:
¹Rocky Mountain Pediatric Surgery, Rocky Mountain Hospital for Children, Denver, Colorado
²Rocky Mountain Pediatric Infectious Disease Consultants, Rocky Mountain Hospital for Children, Denver, Colorado

CITATION:
Knudson BM, Patamasucon P, Lai SW. What is this rapidly growing scalp lesion on a 7-year-old? Consultant. 2022;62(4):e15-e17. doi:10.25270/con.2021.04.00017

Received December 28, 2020. Accepted January 15, 2021. Published online April 30, 2021.

DISCLOSURES:
The authors report no relevant financial relationships.

CORRESPONDENCE:
Sarah W. Lai, MD, MSc, Rocky Mountain Hospital for Children, 2055 High Street, Suite 370, Denver, CO 80205 (sarah.lai@healthonecares.com)

A previously healthy 7-year-old boy presented to our clinic with his parents with a 2-week history of an enlarging left occipital mass. The lesion was initially red, flat, and circular. After the first week, his parents reported that it had doubled in size and began draining serosanguinous fluid. The mass was tender only with palpation. His parents denied a history of trauma, fever, fatigue, headaches, weight loss or night sweats.

A physical examination revealed a 4.0 × 4.0 × 1.5 cm left occipital mass that was centrally ulcerated, covered by a golden crust, mildly tender, boggy, and fixed in position (Figure 1). There were enlarged, nontender, mobile right posterior auricular and left cervical chain lymph nodes.

Figure 1. Clinical appearance of the patient’s occipital scalp lesion.

Relevant laboratory test results included a white blood cell count of 8030/μL (reference range, 5000-14,500/μL), a neutrophil level of 4830/μL (reference range, 1800-8000/μL), a C-reactive protein level of 0.5 mg/dL (reference range, 0-0.8 mg/dL), an erythrocyte sedimentation rate of 18 mm/hr (reference range, 0-10 mm/hr), and a lactic acid dehydrogenase level of 600 U/L (reference range, 420-750 U/L).

A computed tomography (CT) scan was performed, results of which demonstrated a left occipital soft tissue mass measuring 4.3 × 2.0 × 1.7 cm that extended toward the calvarium. The calvarium was intact without evidence of erosion, permeation, or periostitis. A magnetic resonance imaging (MRI) scan revealed a lobulated, heterogeneous, enhancing left occipital soft tissue lesion measuring 3.8 × 3.8 × 1.4 cm with underlying periosteal thickening. T2 hyperintensity showed adjacent deep scalp soft tissue edema without communication through the calvarium (Figure 2).

Figure 2. MRI of the occipital scalp lesion.

Answer and discussion on next page.