The image is a close-up of the scalp of a female hospital cleaner in her late sixties. She presented to the surgical outpatient clinic stating that she had first noted these lumps a couple of years before.
They are quite painless, but they are slowly enlarging and bare patches are showing over them. She is worried that they might be some sort of a growth.
On examination, these lumps were found to be smooth, attached to the skin, but mobile on the underlying skull. They demonstrated the sign of fluctuation between two fingers (performed in two directions), and transilluminated when a torch was applied to them in the darkened examination cubicle.
What’s the most likely diagnosis ?
