An ulcerated lesion on the scalp

A woman in her 70s presented with a 22×15 mm raised scalp lesion with central ulceration (fig 1). Her medical history included anal squamous cell carcinoma (treated with radical radiotherapy), non-diabetic hyperglycaemia, osteoarthritis, and hypertension. She also recalled a burn to the scalp in early adulthood from a hot comb used for hair styling. Initially, the lesion appeared as a scab with intermittent itchiness and bleeding. Over several years, it gradually enlarged, prompting dermatological referral. Biopsy confirmed nodulocystic basal cell carcinoma (BCC). The patient underwent wide local excision, with histopathology confirming clear margins.