title: Surgical management and outcome of scalp subcutaneous granuloma annulare in children: case report.
abstract: OBJECTIVE
  Subcutaneous granuloma annulare (SGA) is a benign inflammatory disorder that rarely affects the scalp. We report 5 cases of children with SGA scalp lesions and discuss our clinical experience and the characteristic findings, diagnostic evaluation, method of treatment, and course of the disease.
  
  
  METHODS
  Five patients presented with multiple subcutaneous nodules at single or multiple sites overlying the scalp. A retrospective review of the medical, surgical, and pathology records of the 5 patients was conducted.
  
  
  METHODS
  All scalp lesions were excised and were confirmed histologically to be SGA nodules. In 4 of the 5 patients, the nodules were nontender and nonmobile. The mean number of lesions was 4.2. The mean age of patients at presentation was 3.8 years. Of the 5 patients, 4 experienced at least 1 recurrence of a solitary lesion at either the same site or a different site. In the 80% of patients who experienced a recurrence, all lesions recurred less than 1 year postoperatively, except in the case of 1 patient who continued to experience a disappearance and reappearance of lesions at 72 months. The ultimate diagnosis of all lesions was established through biopsy and subsequent microscopic evaluation. No postoperative complications were noted.
  
  
  CONCLUSIONS
  Granuloma annulare should be included in the differential diagnosis whenever a scalp subcutaneous superficial nodule is observed. Although many modalities of treatment for SGA nodules are used, recurrence is common, even with surgical excision.
authors.affiliation: Department of Neurological Surgery, University of Washington School of Medicine, Seattle Children's Hospital and Regional Medical Center, Seattle, Washington 98105, USA.
authors.forename: Pawel P
authors.initials: PP
authors.lastname: Jankowski
authors.forename: Phari H
authors.initials: PH
authors.lastname: Krishna
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Rutledge
authors.forename: John
authors.initials: J
authors.lastname: Waldhausen
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Avellino
mesh_terms: D002648:Child; D002675:Child, Preschool; D003094:Collagen; D003937:Diagnosis, Differential; D005260:Female; D016460:Granuloma Annulare / Q000175:diagnosis / Q000601:surgery*; D006644:Histiocytes / Q000473:pathology; D006801:Humans; D008297:Male; D012008:Recurrence; D012075:Remission, Spontaneous; D012535:Scalp / Q000473:pathology* / Q000601:surgery*; D040521:Subcutaneous Tissue / Q000473:pathology* / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003094:Collagen