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Scalp nodule in an elderly woman-quiz case.

An 80-year-old woman presented with a large tumor that had been present on the back of her scalp for 2 to 3 years. She reported occasional pruritus, but the lesion was otherwise asymptomatic. The lesion had grown slowly over the past few years. The patient denied any recent weight loss, increased fatigue, or abdominal pain. On physical examination, a 50 45-mm pink, opaque, firm, and fixed nodule with overlying telangiectasia was noted over the left posterior scalp (Figure 1). A shave biopsy specimen was obtained to establish a diagnosis (Figure 2 and Figure 3). The remainder of the cutaneous examination findings were unremarkable. Given the fixed nature and size of the lesion, a computed tomographic (CT) scan was performed to rule out bony involvement. Of note, the patient had refused all recommended health maintenance screenings, including a mammogram, Papanicolaou test, and colonoscopy. What is your diagnosis?