PMC8660971_01
Timeline.
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F1
Surgery at Zealand University Hospital (ZUH), Koege, in October 2019, for a lipoma on the scalp measuring approximately 5 cm in diameter (for timeline see Figure 1). She had no B-symptoms.
(A) One of the two smaller trichilemmal cysts (TCs). (B) Proliferating trichilemmal cyst (PTC) peroperative. (C) PTC with an ulcerating center. (D) Defect after removal of PTC. (E) Closure with local fasciomusculocutaneous flaps. (F) Small wound 6 months after primary closure.
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F2
At first consultation in October 2019, a sizeable painless tumor of 4 x 5 x 5 cm and two smaller tumors were found on the scalp (Figure 2B). We reconstructed the extensive scalp defect caused by the tumor resection with local fasciomusculocutaneous flaps (Figure 2). The wound was almost healed by March 2021, where only a minor defect was present as seen in Figure 2F.
(A) One of the two smaller TCs. (B) PTC axial view. (C) PTC coronal view. (D,E) Macroscopy of the PTC. (F) Macroscopic view of sliced PTC. (G) Microscopy of PTC, depicting surface epithelia and a tumor process. (H) Microscopy depicting the compact keratin and calcifications. (I) Microscopy with squamous epithelial cells without a granular cell layer.
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F3
A CT scan from July 2020 showed a marked progression of an extracranial tumor compared to a CT cerebrum, which was performed because the proband had cerebral apoplexy in 2012 (Figure 3). Macroscopic examination (Figure 3) showed a skin-covered tumor with craterlike ulceration, measuring 47 mm in height and 50 x 50 mm at the base with the fascia intact.