Enlarging Scalp Nodules on 56-Year-Old Patient

A 56-year-old Caucasian male presented with an approximately 25-year history of gradually enlarging, asymptomatic scalp nodules. His father, unavailable for examination due to his death in an auto accident decades earlier, had a nearly lifelong history of many 2-mm to 3-mm flesh-colored papules both in his nasolabial folds and on his upper lip. The patient’s sister had similar scalp nodules. Results of a recent routine laboratory panel were entirely normal. One medium-sized nodule was removed by deep shave biopsy and submitted for histologic examination. It demonstrated large, lobulated nests of basaloid cells arranged in a jigsaw puzzle pattern.