Reddish Mass with Blood Crust

1.7-year-old girl with recurrent bleeding of a midline mass over the vertex. The history and the local findings - a reddish prominent mass with a blood crust (to avoid profuse bleeding the hair was left standing) - reminds of a hemangioma or a vascular malformation. But also an infected epidermoid cyst fits the local findings. Hemorrhage, infection, or rapid growth are indications for surgery in hemangioma of the scalp; an excision with some type of transposition flap has the advantage of one- stage treatment and avoidance of a hairless zone, in contrast to other options of treatment. During excision possible intracranial vascular connections have to be considered mainly to the superior sagittal sinus.