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

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.