A 12 year old girl presents with a yellowish “bihmark” on the scalp. Her mother repos that the lesion has progressively become thicker and way. She is asymptomatic but they are concern regarding the cosmetic appearance. Which is the most likely diagnosis?
**Core Concept**
A keratin-filled skin lesion with progressive thickening and enlargement, typically presenting as a yellowish discoloration on the scalp, is characteristic of a type of epidermal inclusion cyst that can be caused by trauma or friction.
**Why the Correct Answer is Right**
The likely diagnosis is a sebaceous tricholemmoma or more specifically, a keratin-filled epidermoid cyst, which is a type of epidermal inclusion cyst caused by the entrapment of skin cells. This type of cyst is often found on the scalp, face, or neck, and can be caused by trauma, friction, or congenital factors. The sebaceous tricholemmoma can be distinguished from a keratin-filled epidermoid cyst by its specific location and histopathological features.
**Why Each Wrong Option is Incorrect**
* **Option A:** A pilomatricoma is a rare skin tumor that can present as a keratin-filled lesion but is typically smaller and more mobile than an epidermoid cyst.
* **Option B:** A seborrhoeic keratosis is a benign skin growth that can present as a brown or black lesion but is not typically keratin-filled or caused by trauma.
* **Option C:** A basal cell carcinoma is a type of skin cancer that can present as a slow-growing, painless lesion but is not typically keratin-filled or caused by trauma.
* **Option D:** A dermatofibroma is a benign skin tumor that can present as a firm, painless nodule but is not typically keratin-filled or caused by trauma.
**Clinical Pearl / High-Yield Fact**
Sebaceous tricholemmomas can be distinguished from other keratin-filled lesions by their specific location and histopathological features, and are often caused by trauma or friction, making them a common finding on the scalp, face, or neck.
**Correct Answer:** A.