A sinister case of alopecia in a middle-aged woman

We present the case of a middle-aged woman who presented with multiple indurated areas of hair loss on her scalp. Closer dermoscopic inspection of these patches revealed multiple arborizing vessels on an erythematous background. On further inspection nodules were also noted on the nape of the neck and right breast. Punch biopsies showed diffuse infiltration of the dermis by a neoplastic population of cells with moderate nuclear pleomorphism, abundant eosinophilic cytoplasm and brisk mitotic activity.