Scalp Haematoma - An Unusual Clinical Presentation of a Desmoplastic Neurotropic Melanoma

Case Report

Austin J Dermatolog. 2014;1(1): 1005.

Scalp Haematoma – An Unusual Clinical Presentation of a Desmoplastic Neurotropic Melanoma

CLeitner1, VBisbiroulas1, VPapaefthymiou1, A Hall2, ELadoyanni1*

1Department of Dermatology, the Dudley Group Hospitals NHS Foundation Trust, UK

2Department of Radiology, Russells Hall Hospital, UK

*Corresponding author: Evmorfia Ladoyanni, The Dudley Group Hospitals NHS Foundation Trust, Department of Dermatology, Corbett Hospital, Vicarage Road, Stourbridge, DY8 4JB, United Kingdom,

Received: February 27, 2014; Accepted: April 16, 2014; Published: April 18, 2014


Initial assessment of patients with unwitnessed head injuries is heavily reliant on an accurate patient history of preceding trauma. Initial management often follows blindly strict hospital protocols.

This is illustrated by the case of a 90 year old, demented man who developed a haematoma–like lesion on the scalp to the site of an unwitnessed head trauma. The haematoma was confirmed by a CT but instead of slow reabsorption of the bleed, an ulcerated, nodular lesion developed rapidly. On representation 6 months later, a skin biopsy diagnosed a desmoplastic neurotropic melanoma which was at that stage already metastasised.

Thinking outside the box when assessing patients with soft tissue masses at sites of presumed unwitnessed head trauma is vital and awareness of the limitations of diagnostic tools is essential for every clinician who potentially faces this situation, also dermatologists. Planned follow–ups reserved for this small patient cohort only could be life–saving.

Keywords: Desmoplastic neurotropic melanoma, Haematoma, Computer tomography, Soft tissue tumour


CT–Computed Tomography; DNM – Desmoplastic Neurotropic Melanoma

Case Presentation

A 90–year–old man with known dementia and hypertension presented to the dermatology clinic with an ulcerated lesion on his left scalp (Figure 1). His daughter gave a history of an un witnessed trauma to this area caused by a metal bar six months prior which had caused bruising only. At the time of this presumed head trauma he had been admitted with acute confusion and a computed tomography (CT) scan of his head had ruled out an intracranial hemorrhage. It had however shown a small subcutaneous soft tissue swelling in the left fronto–parietal scalp that had been diagnosed as haematoma in correlation with the history (Figure 2a). The bruise did not resolve, and started enlarging suddenly and rapidly within 5 weeks prior to presentation to the dermatology department. Clinically, a 6x5cm indurate erythematous plaque with central ulceration was apparent on the left frontal scalp (Figure 1). No palpable regional lymphadenopathy was present. An incision skin biopsy revealed a desmoplastic neurotropic melanoma (DNM) of 5.23 mm thickness. The lesion was widely excised but metastases to scalp, lungs, cervical, and mediastinal lymph nodes developed subsequently and the patient passed away within six months of diagnosis. Comparison of the initial CT head with the staging CT six months later (Figure 2b), showed that the “haematoma” in the left fronto–parietal scalp had significantly increased in size and a new nodule in the right frontal scalp had appeared.

Citation: CLeitner, VBisbiroulas, VPapaefthymiou, A Hall, ELadoyanni. Scalp Haematoma - An Unusual Clinical Presentation of a Desmoplastic Neurotropic Melanoma. Austin J Dermatolog. 2014;1(1): 1005. ISSN:2381-9197