Differential Diagnosis

  • Neuroblastoma
  • Merkel cell carcinoma
  • Rhabdomyosarcoma
  • Epidermoid cyst


This boy has a rhabdomyosarcoma (RMS), a malignant mesenchymal tumor of skeletal muscle derivation. Though rare in adults, it is the most common soft tissue carcinoma in children and adolescents.



  • Primary cutaneous RMS most often occurs due to invasion from deeper structure or a frank metastatic event; secondary cutaneous RMS represents advanced disease with a poor prognosis
  • RMS can occur anywhere in the body, but is more likely to originate in the head and neck; the urinary system (including the bladder); the reproductive system; or the arms and legs
  • Genetic syndromes and maternal factors associated with childhood RMS include parental cocaine and marijuana use, Li-Fraumeni syndrome, neurofibromatosis type 1, Beckwith-Wiedemann syndrome, and Costello syndrome


Pearls for Urgent Care Management and Considerations for Transfer

  • Emergent transfer is not necessary, but immediate referral to the child’s pediatrician is advisable. Ultimately, the child should be seen by a pediatric oncologist as soon as possible


Acknowledgment: Image courtesy of VisualDx.

A 2-Year-Old with a Nodule on His Face—and Other Concerning Symptoms
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