What’s the most likely diagnosis? A 52-year-old African-American woman with a 20-year history of systemic lupus erythematous presented with a tender growth on her scalp (Fig 1). The lesion was present for several months and grew quickly in size. She has been on hydroxychloroquine, 200 mg twice daily for 10 years, without adverse events. On examination, a 4-cm tender ulcerated plaque with a raised border on the edge of a depigmented plaque along with additional depigmented plaques with alopecia in the frontal scalp were seen. Laboratory findings were remarkable for mild leukopenia and normocytic anemia. A biopsy specimen is shown in Figs 2 and 3.
A. Cutaneous sarcoidosis
B. Lupus erythematosus panniculitis
C. Poorly differentiated squamous cell carcinoma
D. Proliferating pilar tumor
E. Ulcerated lichen planopilaris
