Clinical Challenge: A Lesion on the Scalp

The patient is an 86-year-old woman who presents for evaluation of a growth on her scalp. The lesion has been present for several years and occasionally bleeds when traumatized by combing. Past medical history is positive for hypothyroidism and chronic obstructive pulmonary disease, and she is a former smoker. Examination reveals a 1.2-cm erythematous, well-demarcated nodule.