CPD • Clinicopathological case CED Clinical and Experimental Dermatology Two large nodules on the scalp of a 60-year-old woman Y. Yuyucu Karabulut 1 and E. S ß enel 2 1 Department of Pathology, Faculty of Medicine, Mersin University, Mersin and 2 Department of Dermatology, Faculty of Medicine, Hitit University, C ß orum, Turkey doi: 10.1111/ced.12468 Clinical findings A 60-year-old woman presented with a 2-year history of two large nodules on her head. She also reported a 1-year history of intermittent mild headache. On phys- ical examination, two nodules were seen, located on the occipital region of the patient’s head. The larger nodule was 51 9 45 mm in size, of a greyish-white colour, and was ulcerated, lobulated and sharply demarcated from neighbouring structures (Fig. 1). The smaller nodule was smooth and rounded, with a diam- eter of 39 mm (Fig. 1). Both nodules were totally excised and sent for histological examination. Histopathological findings The smaller lesion was found to be sharply demarcated from the surrounding tissue. Histopathological exami- nation disclosed a well-defined lobular proliferation of squamous cystic islands centred in the dermis (Fig. 2). The larger lesion had the same histopathological fea- tures, and also had ulceration on its surface. No cellu- lar atypia or surrounding connective tissue invasion were seen. What is your diagnosis? Correspondence: Dr Engin S ßenel, Department of Dermatology, Faculty of Medicine, Hitit University, C ß orum 19100, Turkey E-mail: enginsenel@enginsenel.com Conflict of interest: the authors declare that they have no conflicts of interest. Accepted for publication 27 April 2014 Figure 1 Two large nodules in the occipital region. Figure 2 Well-defined lobular proliferation of squamous cystic islands centred in the dermis, with foreign body macrophages around the nodules and single-cell keratinization within the nodules. Clinical and Experimental Dermatology 1 ª 2014 British Association of Dermatologists CPD