gorlin - goltz syndrome ( ggs ) , or nevoid basal cell carcinoma syndrome , is an autosomal dominant genetic disease with an estimated prevalence of 1:57,0001:256,000 and a high level of penetrance and variable expressiveness [ 1 , 2 , 3 ] . calcification of the falx cerebri is one of the major diagnostic criteria of ggs that can be detected in 79% of patients with ggs . a 53-year - old woman was referred to a radiologist for performance of a routine computed tomography scan of the head to exclude intracranial hemorrhage after accidental head trauma . the computed tomography imaging detected lamellar calcification of the falx cerebri , which is a pathognomonic feature of ggs ( fig . 1 ) . meeting the criteria for ggs and considering the pathognomonic feature of the lamellar calcification ( major criterion for ggs ) , the patient was referred to the department of dermatology . an examination of the patient 's skin showed multiple small lesions clinically resembling basal cell carcinomas ( bccs ) on the back , for which shave excisions were carried out . pathologic examination of the lesions revealed 9 superficial bccs on the back and 1 nodular bcc on the nose . the patient reported that the first bcc had occurred at the age of 27 years , and subsequently 4 other superficial bccs had been removed by shave excision until the diagnosis of ggs was established . furthermore , the patient presented with multiple palmar pits and marked syndactyly of the toes . therefore , in our case , 2 major criteria [ ( i ) lamellar calcification of falx cerebri , and ( ii ) more than 2 bccs ] and 1 minor criterion ( marked syndactyly of digits ) were detected . additionally , the diagnosis of ggs was confirmed by positive testing for mutations in the tumor suppressor gene ptch . taking into account that ggs is an autosomal dominant genetic disease with nearly full penetrance and variable expressivity , the daughters of our patient were screened for ptch gene mutations as well . although they both had no bccs upon clinical inspection and none recorded in their medical history , one of the daughters tested positive for a ptch gene mutation . as a consequence , our patient and her daughter are now being screened for bccs on a regular basis as well as having been made aware of the necessity for adequate primary prophylaxis of skin cancer , such as the avoidance of excessive exposure to ultraviolet radiation . as ggs is a genetic syndrome affecting different organs , early recognition of the specific criteria for ggs is crucial [ 8 , 9 ] . in our case , the incidental finding of lamellar calcification of the falx cerebri of the head finally led to the diagnosis of ggs . this work was partly funded by a research grant from the german research foundation ( gu1271/2 - 1 ) to e.g.
here , we report the case of an incidental finding of lamellar calcification of the falx cerebri in a routine computed tomography scan of the head after an accidental trauma . this lamellar calcification led to the diagnosis of gorlin - goltz syndrome ( ggs ) in the patient and her daughter . 
 lamellar calcification of the falx cerebri is a pathognomonic feature of ggs . 
 our case report highlights the importance of a multidisciplinary diagnostic approach to ggs .