Removing this Large Growth on the Frontal Scalp of a very nervous patient

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• published: 03 Feb 2016
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As you will see, this growth was truly a struggle to remove. And now that I know the pathology results, I now understand why. So, to back up a little, this patient is a wonderful, sassy man, who is an employee of a friend of mine. It was VERY difficult to get him into the office to see me. When I saw him for the first time, he was extremely nervous about being in my office. He HATES doctors. He told me a story about when he had to have a surgery and they gave him a little anesthesia and he almost died (these are his words). Of course, there are many people like him in this world, who have had bad experiences in doctors' offices or may just have extreme fear about being examined by a doctor or having a medical procedure. So, this is why he waited so very long to have this bump removed. And I knew that he had been manipulating this area, trying to get rid of it himself. Pushing on it and squeezing material out of it... from his descriptions, I thought he could have a pilar cyst which he had pushed and squeezed so many times that it had a lot of scar tissue. However, as I began to try to excise this growth, I suspected that this could be something different. And if I had known beforehand, coupled with the knowledge that he was difficult man to get into the office in the first place because of his fear of surgery, I would have probably done a more involved, extensive surgery to get rid of this growth completely. I would have excised the entire bump (not just made a cut in the center to try to evacuate a presumed cyst/sac and contents), which likely would have required a graft (I don't think I could close that large of an area primarily/side to side closure). So, as you can see, this excision took me longer than expected... it wasn't straight forward. And then I got the pathology report on the tissue, which confirmed that this was not a pilar cyst at all. He has a Proliferating Follicular Cystic Neoplasm which is a trichilemmal tumor. A trichilemma tumor is a type of growth originating from the hair follicle. Yes, it had cystic elements which is why it looked a little like a pilar cyst which is the most common type of cystic growth on the scalp. This growth he has is a variant of squamous cell carcinoma, which is a type of skin cancer. However, this has an extremely low likelihood of spreading elsewhere on the body (very low risk of metastasis), so it is likely mainly just locally destructive. I explained all of this to him and told him that I recommend that he remove the entire growth via Mohs Micrographic Skin Cancer surgery, which is the best was to remove a growth like this with the lowest recurrence rate while also removing as little skin as possible, thereby most likely creating the smallest scar possible. This is all done under local anesthesia. I think you all can tell he is still fearful of us doctors. Let's hope he returns soon. These types of skin cancers are typically slow growing but won't just disappear. They need to be excised completely. Stay tuned, as of the date of this video being published, he has not yet called back to schedule another appointment. Thank you so much for watching! For more content, exclusive content, and of course to get your Dr. Pimple Popper schwag, visit us at www.drpimplepopper.com! Instagram: @DrPimplePopper for 24/7 pops @DrSandraLee for my work, my life, my pops Facebook: facebook.com/DrSandraLeeDermatology Twitter: @SandraLeeMD Snapchat: drpimplepopper Periscope: Dr. Sandra Lee This video may contain dermatologic surgical and/or procedural content. The content seen in this video is provided only for medical education purposes and is not intended to be a substitute for professional medical advice, diagnosis, or treatment.