Calvarial involvement of LCH more often involves the parietal or frontal bone before the skull base. Although typically appearing as well defined lesions, they unevenly involve the inner and outer tables, and can also show ill-defined or frayed margins. This results in a beveled margin such as in the image above. These lesions infrequently cross the suture, unlike neuroblastoma metastases, which tend to deposit along and widen the sutures.
Sometimes, an isolated bone island can be seen within the lesion, and referred to as a “button sequestrum”. This supports a diagnoses of LCH, although osteomyelitis can look similar. Mandibular lesions also tend to involve the alveolar bone, giving a “floating teeth” appearance.
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