'You can keep your hat on: a giant forehead trichilemmal cyst

Description

A 70-year-old man was referred to plastic surgery with a progressively enlarging lesion to his forehead. A small nodule had been present since 30 years. The patient had presented to his general practitioner at the time and had been reassured that this was a sebaceous cyst which warranted no further attention. As the lesion continued to grow over the intervening years, the patient did not seek any further medical attention and concealed the lesion under a cap.

On examination, he had a 5x6x6 cm pedunculated, fleshy exophytic tumour on his central forehead (figure 1A), with further nodules each measuring 2–3 cm diameter dotted across his scalp.

Figure 1

(A) Anterior view of the pedunculated forehead lesion. (B) Axial CT showing no intracranial component or bony erosion.

CT showed a heterogeneous midline scalp lesion abutting the outer table of the skull but with...

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