LAUSR

An 85-year-old farmer presented with a painless, gradually progressing proliferative lesion on his left temporal scalp close to pinna. After ignoring it for 22 years, its unexpected rapid growth over the last month made him seek medical attention. It started as a small peanut size swelling that spontaneously discharged jelly-like whitish substance which encrusted over the years to give the present pedunculated appearance. There was no history of trauma, bleeding, or itching at the site. He had no addictions. His past and family histories were insignificant. General physical and systemic examinations were within normal limits. Local examination revealed a 1 × 1 cm globular, non-tender, softtissue swelling on the left temporal scalp with two distinct horn-like structures bifurcating from it. It was free from the underlying structures [Figure 1]. There were no similar lesions elsewhere on the body. There was no associated significant peri-auricular or cervical lymphadenopathy, and the ipsilateral external ear examination did not reveal any abnormality. The patient’s routine hemogram as well as x-rays of the skull and the chest were all normal. Mantoux test was negative. Thus, an excisional biopsy was performed under local anesthesia with a 1 cm margin all around and the wound was closed primarily. The microscopic evaluation revealed basal epidermal atypia and palisading of basal cells without any granulomas. Presence of solar elastosis suggested prolonged sun exposure. However, the squamous epithelial cells did not show pleomorphism or keratinization.