A 63-year-old, otherwise healthy woman consulted us because of ulcerated node on the parietal scalp. She got trauma on her scalp 48 years ago when she was a factory girl. Her parietal hairs were totally removed, leaving alopecia cicatrisata. She had hidden the lesion by a wig over 40 years, and her family did not notice the lesion. Anerosion developed on the alopecic plaque 10 years ago, and the lesion gradually elevated since 2 years. However, she never consulted us, despite she visited us because of eczematous lesion on the trunk. The physical examination revealed an well-demarcated, 11×10cm alopecic scar on the parietal and frontal scalp. A 4.4×7 ×1cm in size, granular-surfaced, cratered node with pus and bloody crust located on thecenter of the plaque. Radiologic examination revealed osteolytic change of the skull and thickening of the dura mater. Biopsy of the node was histologically diagnosed as SCC, and the node and alopecic plaque including affected skull were excised in Neurosurgery department. Totally 150mg of peplomycin sulfate was administrated for the treatment of remaining nodes on the dura mater, however the patient died of pneumonia 5 months after the operation. The present case suggests the importance of careful examination for other than chief complaint of the patient.
