Subcutaneous palisading granulomas, lesions characterized by collagen
necrosis and chronic inflammatory changes, may present as ill-defined,
immobile, nontender masses of the scalp. They are frequently multiple
and may vary in size over time. Imaging studies rarely show involveme
nt of the calvarium. The histological pattern of palisading histiocyte
s around necrobiotic granulomas is seen in association with a variety
of systemic illnesses but more commonly occurs as an isolated entity i
n childhood. They are unlikely to herald rheumatological disease unles
s the erythrocyte sedimentation rate is elevated. In the presence of j
uvenile rheumatoid arthritis, histological confirmation is usually not
indicated. If the lesions are not associated with any other clinical
symptoms excisional biopsy may be indicated to establish a diagnosis.
The nodules need not be removed as they will spontaneously regress.