A giant mass on the forehead

A man in his 80s presented with a one year history of a small red papule on his forehead of unknown cause, which had grown rapidly into a large nodule in the month before presentation. The patient was otherwise well and had not sought help for the condition. He had no noticeable pain or itchiness. Physical examination showed a single, solid dome-shaped red mass measuring 5×3.5 cm on his forehead and characterised by central hyperkeratosis with distinct boundaries (fig 1). The patient had no personal or familial history of sebaceous neoplasms or Lynch syndrome-related visceral malignancy. Histology of a lesion sample showed keratotic plugs surrounded by well differentiated epithelial …