[SavageGlow]

A 27-year-old woman was admitted to the hospital for evaluation of a huge black scalp macule (20 × 18 cm) with thinning of the overlying hair (Figure 1). The asymptomatic scalp macule first appeared upon her birth and gradually increased in size.

We were concerned that the patient did not have enough hair-bearing tissue for scalp reconstruction after surgical excision because of the extensive scope of the lesion. Therefore, a two-stage surgery with reconstruction was finally planned. During the first stage, four rectangular inflatable tissue expanders (300-, 300-, 100-, and 80-mL) were placed under the scalp galea on both sides of the forehead and mastoid regions (Figure 2).

Over a 6-month period, the expanders were inflated twice weekly until they reached a total volume of 1400, 1400, 450, and 400 mL, respectively. During the second stage, full-thickness excision of the lesion with a 0.5-cm skin margin was performed without disturbing the periosteum, and closure was achieved with rotation advancement flaps from the adjacent expanded scalp without perioperative complications (Figure 3).

The patient was diagnosed with CIN according to postoperative pathological findings. During the 6-month postoperative follow-up, there was no evidence of recurrence; only a scar was present under the coverage of the hair.

[Mr.NoCredit]

Those first photos are like wearing a strange skin lump hat.

Nice outcome though!