Case Study: Slowly Enlarging Red Nodule on the Scalp in a 38-Year-Old Female

Case at a Glance

A 38-year-old female presented with a persistent, asymptomatic red nodule on her scalp that she noted had become more raised over the past year. Despite a benign clinical appearance, the patient's anxiety and the reported change in size prompted further investigation.

Patient's Story

The patient, a 38-year-old woman with no significant medical history, presented to a dermatology clinic with concerns about a red bump on her scalp. She reported first noticing the lesion approximately two to three years prior. While it had never caused her any pain, itching, or bleeding, she became increasingly anxious after perceiving that it had become more raised and prominent over the last year. She mentioned having multiple small, flat red spots on her torso for years, but this one on her scalp felt different—soft and 'squishy' to the touch. Fearing a potential malignancy, she decided to seek a professional opinion.

Initial Assessment

Upon presentation, the patient was a healthy-appearing 38-year-old female.

History of Present Illness: The patient pointed to a lesion on her scalp, present for at least two years, with perceived growth (elevation) in the last 12 months. The lesion was entirely asymptomatic, with no associated pruritus, tenderness, or bleeding.

Past Medical History: The patient was not on any chronic medications and reported no history of immunocompromise. She had one previous full-term pregnancy. She noted a long-standing history of multiple, small cherry angiomas on her trunk.

Social History: The patient reported moderate sun exposure during summer months, consistently using sunscreen for protection.

Physical Examination: A physical examination of the scalp revealed a solitary, 6 mm, well-demarcated, dome-shaped, erythematous papule. The lesion was soft and compressible on palpation and non-tender. There were no signs of ulceration, scaling, or surrounding inflammation. Examination of the torso confirmed the presence of multiple, smaller (1-2 mm) cherry angiomas.

The Diagnostic Journey

The primary differential diagnosis for a solitary, soft, red nodule on the scalp included several possibilities. Given the patient's history of similar lesions on her torso and the soft, compressible nature, a benign vascular lesion such as a large cherry angioma was considered most likely. Other considerations included a pilar cyst (though typically skin-colored unless inflamed), a pyogenic granuloma (usually more friable and of recent onset), or a Spitz nevus. Although less likely given the chronicity and lack of symptoms, nodular basal cell carcinoma or amelanotic melanoma were included in the differential to ensure a thorough evaluation, especially given the patient's report of recent change.

Final Diagnosis

Due to the patient's anxiety and the reported change in the lesion's size, an excisional biopsy was recommended and performed. The procedure served both a diagnostic and therapeutic purpose. The specimen was sent for histopathological analysis, which confirmed the diagnosis of a Capillary Hemangioma (Cherry Angioma). The pathology report noted a proliferation of benign capillaries in the papillary dermis, consistent with the clinical diagnosis.

Treatment Plan

The excisional biopsy completely removed the lesion. The small wound was closed with simple interrupted sutures. The patient received post-procedure wound care instructions. A key component of the treatment was providing reassurance and education regarding the benign nature of the lesion, which directly addressed her primary concern.

Outcome and Follow-up

The patient returned one week later for suture removal. The excision site was healing well without any signs of infection or complication. The patient expressed significant relief upon learning the benign nature of the lesion. She was advised to continue performing regular skin self-examinations and to maintain sun-safe habits. A routine annual full-body skin examination was recommended.