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Clinical Quiz: A brain-like scalp nodule

While buying shampoo a lady asks you to look at a lump on her scalp. Although it's been present for many years, she says it has recently started to catch on her comb, and as a result has become sore and tender to the touch.

QUESTIONS

1. This lump has a number of suspicious features and the patient should be referred to their GP. True or false?

2. In cases where the lesion is visible through the hair or catching on combs a simple surgical procedure can be performed that is usually curative. True or false?

3. Secondary fungal infections are a common cause of tenderness with this type of nodule. An antifungal shampoo should be recommended and used once a week. True or false?

4. This type of lesion is hereditary and it is likely increasing numbers will develop throughout the patient's life. True or false?

5. The patient can be reassured this lesion doesn't necessarily have to be removed and that repeated trauma from a comb or brush wont cause malignant change to occur. True or false?


DISCUSSION


1. False. This type of fleshy naevus is quite common on the scalp and no treatment is necessary.

2. True. The best form of treatment is a shave excision, which doesn't require stitches and is usually curative.

3. False. There is no association between this type of lesion and fungal infection. Any shampoo can be used to wash adjacent hair.

4. False. Although this type of lesion is common there is no hereditary component and multiple lesions are uncommon.

5. True. Symptomatic treatment isn't recommended and malignant change isn't likely occur, even if repeated trauma occurs.

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