A Scalp Wound That Won’t Heal on a Retired Construction Worker

Calvin Tilson, BA; Gabrielle Schwartzman, MD; Richard Harold Flowers IV, MD


March 06, 2023

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 66-year-old man presents with a 2-year history of a nonhealing scalp wound. He reports occasional scalp blistering and denies oral or mucosal lesions. He had unsuccessfully treated the scalp wound with an over-the-counter antibiotic ointment and gauze bandages.

The patient has a personal history of actinic keratoses of the scalp and low-grade squamous cell carcinoma of the arm, treated with liquid nitrogen and surgical excision, respectively. He also has type 2 diabetes mellitus, which is controlled with metformin, and congestive heart failure with hypertension, which is controlled with bumetanide and carvedilol. He is a retired construction worker who had significant sun exposure in his youth. His family history is negative for autoimmune disease but positive for nonmelanoma skin cancer in his parents.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.