Causes:
1. Traumatic:
- Hematoma
- Cephalhaematoma
2. Sabaceous cysts.
3. Neoplastic:
- Bening - Ivory osteoma
- Malignant: basal cell carcinoma, Squamous cell carcinoma, malignant melanoma, myeloma
- Secondary metastases from breast, bronchus, thyroid, prostate.
4. Infective:
- Cock's peculiar tumor
- Tinea capitis
5. Others:
- Psoriasis
- Seborrhoeic dermatitis.
Clinical History And Physical Examination:
1. Hematoma: A history of truama will be present and a boggy hematoma may overlie a skull fracture. X ray is required to exclude an underlying fracture.
2. Cephalhematoma: is seen in newborn babies following a traumatic delivery. The hematoma spreads beneath the periosteum of the skull and is therefore limited by skull sutures.
Cephalhematoma
3. Sebaceous cysts: these may be multiple and noticed when combing the hair. The sebaceous cysts are spherical tender, firm swellings in the scalp. rarely a punctum is visible with a sebaceous cyst on the scalp.
Sebaceous cysts
4. Ivory Osteoma; A benign lesion which may present as a rock hard swelling on the scalp. The patient is usually a young adult and asymptomatic. The skin is freely mobile over it.
Ivory Osteoma
Squamous cell carcinoma
6. Malignant Melanoma: is usually pigmented, ulcerated and bleeds. Cervical lymphadenopathy may be present.
Malignant Melanoma
7. Basal Cell carcinoma: is a raised ulcer with a rolled edge with a pearly appearance often with superficial telengiectasia
Basal Cell carcinoma
8. Myeloma: may present with painful lesions in the skull with areas of localized tenderness.
9. Cock's Peculiar tumor: is due to a sebaceous cyst infection which suppurates and granulation tissue appears on its surface. Patient may present with a sore , bleeding lesion on the scalp. It may be mistaken for a squamous cell carcinoma.
Cock's Peculiar tumor
10. Tinea Capitis: there are red , scaly patches on the scalp , with broken hairs. Usually seen in children.
Tinea Capitis
11. Psoriasis: may affect the scalp and there may be history of lesions elsewhere. There are well demarcated areas of scales heaped up over red plaque. The hair grows normally through the plaques.
Scalp Psoriasis
12. Seborrhoeic dermatitis: shows fine scales with intact hair
Seborrhoeic dermatitis
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