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Dai Z, He Y, Zhang X, Tian Z, Zhu G, Ren Z, Ye L, Liu Z, Ma C, Cao W, Ji T. Head-and-neck dermatofibrosarcoma protuberans: Survival analysis and Clinically relevant immunohistochemical indicators. Oral Dis 2024; 30:1040-1051. [PMID: 36597156 DOI: 10.1111/odi.14495] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/28/2022] [Accepted: 12/30/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Head and neck dermatofibrosarcoma protuberans (HNDFSP) is extremely rare and not entirely understood. OBJECTIVE To investigate the clinicopathological features of HNDFSP and identify the expression of its clinically relevant indicators, with the expectation of improving the existing treatment strategies. METHODS A long-term follow-up of patients with HNDFSP who received treatment between 2000 and 2021 at Shanghai Ninth People's Hospital was conducted. The clinical, histological, and immunohistochemical data of the patients were retrieved and analyzed. The endpoint of the study was the incidence of significant disease-related clinical events (recurrences or metastasis). RESULTS A total of 49 patients with HNDFSP were included in the study, with males (92.7%) predominating than females (7.3%). Eighteen patients developed recurrent disease (36.8%) after surgery, and the median time of recurrence was 48 months (interquartile, 20-74 months). Metastasis occurred in two cases (4.1%). Two patients died during follow-up, both with local recurrence, and one of them with intestinal metastasis. Post-operation radiotherapy was administered to eight patients (16.3%) and the effect in local control was remarkable. Age, tumor size, and negative margins with sufficient safety width were the main independent factors affecting the disease-free survival. Several potential targeted therapeutic indicators, including EZH2 (80.0%), EGFR (91.4%), PDGF (97.1%), PD-L1 (77.1%), and VEGF (77.1%), were positively expressed in most tumor samples. CONCLUSION HNDFSP is rare, significantly challenging to control locally, and has a worse prognosis with current treatment strategies. Wide local excision and long-term follow-up are needed. Radiotherapy could improve the prognosis of patients with HNDFSP.
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Affiliation(s)
- Zhenlin Dai
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Disease, Shanghai, China
| | - Youya He
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Disease, Shanghai, China
| | - Xu Zhang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Disease, Shanghai, China
| | - Zhen Tian
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Disease, Shanghai, China
- Department of Oral Pathology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guopei Zhu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Disease, Shanghai, China
| | - Zhenhu Ren
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Disease, Shanghai, China
| | - Lulu Ye
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Disease, Shanghai, China
| | - Zheqi Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Disease, Shanghai, China
| | - Chunyue Ma
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Disease, Shanghai, China
| | - Wei Cao
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Disease, Shanghai, China
| | - Tong Ji
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Disease, Shanghai, China
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Varghese BT, Nadarajan AR, Thomas S, Iype EM, George NA, K M JK, Lal SS, Somanathan T. Spectrum of malignant scalp tumours and its impact on management-a tertiary care cancer centre experience. World J Surg Oncol 2023; 21:330. [PMID: 37845728 PMCID: PMC10580575 DOI: 10.1186/s12957-023-03200-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/23/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Tumours on the scalp are diverse and often exhibit site- and histology-specific characteristics. Reconstructing the scalp after oncological resection has always been challenging because of its unique anatomy. METHODOLOGY A retrospective review of patients with malignant scalp tumour operated on at a single institution over 10 years was performed. Data were collected and analysed regarding the scalp tumour profile, treatment, and the outcome of these procedures. RESULTS Of the 66 patients in our study, 33 (50%) had SCC. In addition to this, 21% were sarcomas, 17% were appendageal carcinomas, 11% were BCCs, and 1% was neuroendocrine carcinoma. Cortical erosion was observed in 6 patients in the CT imaging, all with SCC histology. Among the eight patients with pathological nodal involvement, three had angiosarcoma, three had SCC, one had appendageal carcinoma, and one had neuroendocrine carcinoma. The mean surgical defect size was 67.4 cm2. The surgical defect was reconstructed with local flaps in 58% of patients and primary closure in 27%. Local and systemic recurrence was noted in 25% of patients. Tumour size more than 6 cm, tumour histology (SCC & sarcoma), unplanned margin-positive excision, and residual disease in re-excision had higher recurrence, even though the p-value was not significant. CONCLUSION Scalp tumours are heterogeneous in their clinical profiles. Often, its tumour biology and microscopic extent are underestimated. High suspicion, histological diagnosis, and clear surgical margins are all requirements in successfully treating scalp tumours. In order to minimize morbidity and restore an aesthetic and functional outcome, it is critical to use the simplest scalp reconstruction whenever possible.
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Affiliation(s)
- Bipin T Varghese
- Department of Head and Neck Oncology, Regional Cancer Center, Thiruvananthapuram, India
| | - Abinaya R Nadarajan
- Department of Surgical Oncology, Regional Cancer Center, Thiruvananthapuram, India.
| | - Shaji Thomas
- Department of Head and Neck Oncology, Regional Cancer Center, Thiruvananthapuram, India
| | - Elizabeth Mathew Iype
- Department of Head and Neck Oncology, Regional Cancer Center, Thiruvananthapuram, India
| | - Nebu Abraham George
- Department of Head and Neck Oncology, Regional Cancer Center, Thiruvananthapuram, India
| | | | - Sahya S Lal
- Department of Head and Neck Oncology, Regional Cancer Center, Thiruvananthapuram, India
| | - Thara Somanathan
- Department of Pathology, Regional Cancer Center, Thiruvananthapuram, India
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Singh A, Singh C, Sood R, Prakash G. Aggressive large B cell lymphoma mimicking turban tumor. INDIAN J PATHOL MICR 2023; 66:674-676. [PMID: 37530372 DOI: 10.4103/ijpm.ijpm_778_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Affiliation(s)
- Ashish Singh
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Charanpreet Singh
- Department of Clinical Hematology and Medical Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ridhi Sood
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Prakash
- Department of Clinical Hematology and Medical Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Zhang L, Wang J, Yang S, Lu L, Yu X. Nasal Alar and Scalp Metastases From Lung Carcinoma: A Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2023:1455613231177984. [PMID: 37264890 DOI: 10.1177/01455613231177984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Both nasal alar and scalp metastases from lung carcinoma are exceedingly rare. Herein, we report a case of an elderly male smoker who had left lung carcinoma and underwent radical resection. Seven months later, masses began to appear on his nasal alar and parietal scalp which gradually increased in size. The nasal computed tomography and head magnetic resonance imaging scan revealed a dense soft tissue shadow in the right nasal alar and nasal cavity, as well as a soft tissue nodule in the middle of the parietal scalp. A biopsy was performed and immunohistochemistry suggested poorly differentiated metastatic carcinoma that was consistent with the characteristics of primary lung carcinoma and supported the diagnosis of nasal alar and scalp metastases. Then, he received a combined treatment of Albumin paclitaxel and Xindirizumab. However, he passed away 3 months later. In addition to this case, we also review the clinical features of nose and/or scalp metastases from lung carcinoma based on previously reported cases as well as this case.
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Affiliation(s)
- Lu Zhang
- Department of Otorhinolaryngology, Ningbo No.2 Hospital, Ningbo, Zhejiang, China
| | - Jiyun Wang
- Department of Otorhinolaryngology, Ningbo No.2 Hospital, Ningbo, Zhejiang, China
| | - Sijia Yang
- Department of Respiratory Medicine, Ningbo No.2 Hospital, Ningbo, Zhejiang, China
| | - Lu Lu
- Ningbo Clinical Pathology Diagnosis Center, Ningbo, Zhejiang, China
| | - Xiao Yu
- Department of Otorhinolaryngology, Ningbo No.2 Hospital, Ningbo, Zhejiang, China
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Abdulraheem AM, Naji D, Al Heyasat AN, Alhasan M, Almasri NM, Odeh R. Breast cancer with scalp metastases: a case report. J Med Case Rep 2023; 17:203. [PMID: 37198611 DOI: 10.1186/s13256-023-03928-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/11/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND While breast cancer is the most common cancer in women, cutaneous metastases are rare in breast cancer. Additionally, scalp involvement in breast cancer metastasis is extremely rare. That being said, scalp lesions should always be thoroughly investigated to distinguish metastatic lesions from other neoplasms. CASE PRESENTATION A 47-year-old female Middle-Eastern patient presented with metastatic breast cancer in the lungs, bone, liver, and brain with no signs of multiple organ failure, in addition to cutaneous metastases, including the scalp. Between 2017 and 2022, she was managed through modified radical mastectomy, radiotherapy, and several lines of chemotherapy. She presented in September of 2022 with enlarging scalp nodules, which started developing 2 months prior to her presentation. Physical examination revealed firm, non-tender, and immobile skin lesions. Magnetic resonance imaging scan of the head showed soft tissue nodules in different sequences. A punch biopsy was taken from the largest scalp lesion and showed metastatic invasive ductal carcinoma. A panel of immunohistochemistry stains was applied, because a single specific marker for differentiating primary cutaneous adnexal tumors or other malignant neoplasms from breast cancer has not yet been identified. The panel showed positive estrogen receptor 95%, progesterone receptor 5%, negative human epidermal growth factor receptor 2, positive GATA binding protein 3, positive cytokeratin-7, negative P63, and negative KIT (CD117). CONCLUSION Breast cancer metastases to the scalp are extremely uncommon. When a scalp metastasis is present, it might be the only symptomatic sign of disease progression or widespread metastatic lesions. However, such lesions warrant a comprehensive radiologic and pathologic workup to rule out other possibilities of skin pathologies, such as sebaceous skin adenocarcinoma as it effects the management plan.
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Affiliation(s)
- Ahmad M Abdulraheem
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan.
- School of Medicine/University of Jordan, Amman, Jordan.
| | - Duha Naji
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
- School of Medicine/University of Jordan, Amman, Jordan
| | - Ammar N Al Heyasat
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
- School of Medicine/Al-Balqa Applied University, Alsalt, Jordan
| | - Mohammad Alhasan
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
- School of Medicine/Jordan University of Science and Technology, Irbid, Jordan
| | - Nidal M Almasri
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Raghad Odeh
- School of Medicine/University of Jordan, Amman, Jordan
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Homer CJ, Richa T. Exophytic Squamous Cell Carcinoma of the Scalp: A Case Report. Cureus 2023; 15:e36741. [PMID: 37123783 PMCID: PMC10139673 DOI: 10.7759/cureus.36741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 03/29/2023] Open
Abstract
Squamous cell carcinoma (SCC) is the second-most common clinical presentation of non-melanoma skin cancer. Despite its prevalence, the rate of growth and development of SCC lesions is low. We present a case report of an exophytic SCC of the midline scalp. Over approximately 18 months, the exophytic portion of this lesion grew to a size of 8.5 x 7 cm due to the fact that the patient did not seek medical attention. The patient suffered from many predisposing factors including active smoking status, type II diabetes, and significant previous sun exposure. In addition to these predisposing factors, the patient did not have comprehensive health insurance to cover outpatient medical care. This case highlights the importance of early intervention in the management of head and neck skin cancers and the negative impact of delayed treatment.
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Tahir M, Knowles K, Turbat-Herrera E, Lazarchick JJ, Liles JS. Scalp Metastasis as an Initial Manifestation of Squamous Cell Carcinoma of the Lung: Case Report of an Extremely Rare Entity. Cureus 2023; 15:e35074. [PMID: 36960245 PMCID: PMC10029702 DOI: 10.7759/cureus.35074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 02/18/2023] Open
Abstract
Cutaneous metastasis of primary visceral neoplasm is an unusual phenomenon. However, cutaneous metastasis as an initial presentation of clinically silent visceral neoplasm is exceedingly rare. We are reporting a unique case of an elderly male patient who presented with a solitary scalp metastasis as an initial manifestation of underlying lung cancer. Further diagnostic evaluation revealed neoplastic primary lung disease. This case report emphasizes the importance of physicians being aware of these unusual clinical presentations of visceral malignancies. It is also critical to order appropriate diagnostic tests promptly to establish an accurate diagnosis and begin the proper treatment for a better prognosis. Skin lesions can be a diagnostic manifestation of lung cancer and predict a poor prognosis. We conclude that in patients with a history of smoking or lung cancer who present with cutaneous lesions, the possibility of skin metastasis of primary lung cancer should always be considered in the differential diagnosis.
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Affiliation(s)
- Muhammad Tahir
- Pathology and Laboratory Medicine, University of South Alabama Hospital, Mobile, USA
| | - Kurt Knowles
- Pathology and Laboratory Medicine, University of South Alabama Hospital, Mobile, USA
| | - Elba Turbat-Herrera
- Pathology and Laboratory Medicine, University of South Alabama Hospital, Mobile, USA
| | - John J Lazarchick
- Pathology and Laboratory Medicine, Mobile Infirmary Medical Center, Mobile, USA
| | - Joe S Liles
- Surgery, University of South Alabama Health System, Mobile, USA
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Chirukandath R, Krishnan SK, Sulaiman SV, Kollannur LK, Nishthar Cmt M. Squamous Cell Carcinoma Scalp With Intracranial Extension: Challenging Case of Multidisciplinary Care. Cureus 2023; 15:e34975. [PMID: 36938224 PMCID: PMC10019751 DOI: 10.7759/cureus.34975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 02/16/2023] Open
Abstract
Squamous cell carcinoma (SCC) of the scalp is the second most common non-melanoma cancer of the skin. The incidence of squamous cell carcinoma on the scalp is on the rise, but the intracranial extension is rare. Cranial invasion is rare in SCC of the scalp, but when present, it is associated with a poor prognosis. A 62-year-old female presented with complaints of swelling over the back of her scalp for three months, which rapidly increased in size. She also had a throbbing headache, alopecia in that area, and multiple episodes of pustules in that area. On examination, she had an ulceroproliferative lesion measuring 5*5*3 cm with an irregular surface and varying consistency over the occipital area in the midline surrounded by ulcerations and crusted discharge and fixed to the bone. Contrast-enhanced magnetic resonance imaging (MRI) showed an irregular lesion with the destruction of the right parietal and occipital bones involving both inner and outer tables with intracranial and extracranial components, and the lesion was abutting the superior sagittal sinus. The treatment is surgical resection of the tumor with margin clearance. The treatment plan was designed using a multidisciplinary approach with the collaboration of oncosurgery, neurosurgery, and plastic surgery. The patient underwent wide local excision of the tumor with adequate skin and cranial bone clearance. The tumor was found to have infiltrated the dura mater overlying the superior sagittal sinus. The defect was then closed using a vault prosthetic cover and a scalp transposition flap from the left parietal area. This case report intends to highlight the need for a multidisciplinary approach to the proper management of advanced squamous cell carcinoma to decrease the morbidity and mortality in patients.
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Affiliation(s)
| | | | - Sumin V Sulaiman
- General Surgery, Government Medical College Thrissur, Thrissur, IND
| | - Lijo K Kollannur
- Neurological Surgery, Government Medical College Thrissur, Thrissur, IND
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9
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Tan B, Seth I, Fischer O, Hewitt L, Melville G, Bulloch G, Ashford B. Sex Disparity for Patients with Cutaneous Squamous Cell Carcinoma of the Head and Neck: A Systematic Review. Cancers (Basel) 2022; 14:cancers14235830. [PMID: 36497312 PMCID: PMC9740937 DOI: 10.3390/cancers14235830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
The incidence of head and neck cutaneous squamous cell carcinoma (HNcSCC) is unevenly distributed between men and women. At present, the mechanism behind this disparity remains elusive. This study conducted a systematic review and meta-analysis of proportions to investigate the disparity between sexes for patients with HNcSCC. PubMed, Scopus, EMBASE, MEDLINE, Emcare and CINAHL were searched in November 2021 and June 2022 (N > 50, English, human), and studies which examined the association between sex and HNcSCC were included. Analysis was conducted using RStudio with data and forest plots displaying males as a proportion of total patients with HNcSCC. Two independent researchers performed study selection, data extraction, data analysis and risk of bias. Eighty-two studies (1948 to 2018) comprising approximately 186,000 participants (67% male, 33% female) from 29 countries were included. Significantly more males had HNcSCC overall (71%; CI: 67−74). Males were also significantly more affected by cSCC of the ear (92%; CI: 89−94), lip (74%; CI: 66−81), and eyelid (56%; CI: 51−62). This study found HNcSCC disproportionately affected males overall and across all subtypes. Improving our understanding of sex-specific mechanisms in HNcSCC will better inform our preventive, therapeutic and prognostic practices.
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Affiliation(s)
- Brandon Tan
- Research Central, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500, Australia
| | - Ishith Seth
- Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
| | - Olivia Fischer
- Research Central, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500, Australia
| | - Lyndel Hewitt
- Research Central, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
- Correspondence: ; Tel.: +61-02-42534801
| | - Geoffrey Melville
- Research Central, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Gabriella Bulloch
- Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Bruce Ashford
- Research Central, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
- Sydney Head and Neck Cancer Institute, Chris O’Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
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Dahal A, Neupane D, Lageju N, Jaiswal LS, Chaudhary S, Budhathoki AC, Sah SP, Subedi SS. Invasive cutaneous squamous cell carcinoma of scalp: A case report. Ann Med Surg (Lond) 2022; 82:104702. [PMID: 36268452 PMCID: PMC9577594 DOI: 10.1016/j.amsu.2022.104702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/11/2022] [Accepted: 09/11/2022] [Indexed: 10/24/2022] Open
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Vernemmen AIP, Li X, Roemen GMJM, Speel EJM, Kubat B, Hausen AZ, Winnepenninckx VJL, Samarska IV. Cutaneous metastases of internal malignancies: a single-institution experience. Histopathology 2022; 81:329-341. [PMID: 35758186 PMCID: PMC9544513 DOI: 10.1111/his.14705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/24/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022]
Abstract
Aims Cutaneous metastases of internal malignancies occur in 1–10% of cancer patients. The diagnosis can sometimes be challenging, especially in cases with an unknown primary cancer. Materials and methods A retrospective case review was performed including all cases of skin metastases from primary internal malignancies diagnosed at the Department of Pathology at the Maastricht University Medical Centre+ from 2007 to 2021. The clinicopathological data were collected and immunohistochemical and molecular diagnostic tests were performed to confirm the primary origin of the metastases. Results We identified 152 cases (71 female; 31 male patients) of cutaneous metastases of internal malignancies. 28 patients (20 women and 8 men) were diagnosed with multiple cutaneous metastases. Among the female patients, the most common primary tumour was breast cancer (50% of the cases), followed by lung (13.6%), gynaecological (7.3%), and gastrointestinal origin (7.3%). Among the male patients, the most common primary sites were gastrointestinal and lung origin (altogether, 50% of the cases). In 19 patients, the cutaneous metastasis was the first presentation of a clinically silent internal malignancy (18.6%), of which most (78.9%) represented metastatic lung carcinomas. Finally, metastasizing patterns were different across tumour types and gender. Conclusion Breast, lung, gastrointestinal, and gynaecologic cancers are the most common primary tumours demonstrating skin metastases. Infrequently, cutaneous metastases can be the first clinically visual manifestation of an underlying not yet diagnosed internal malignancy; therefore, occasional broad immunohistochemical profiling, molecular clonal analysis, and a continuous high level of awareness are necessary for a precise diagnosis of cutaneous metastases of internal malignancies.
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Affiliation(s)
- Astrid I P Vernemmen
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Xiaofei Li
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Guido M J M Roemen
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ernst-Jan M Speel
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Bela Kubat
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Axel Zur Hausen
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Véronique J L Winnepenninckx
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Iryna V Samarska
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Busbait S, Alkhalifa AM, Aljohani S, Alhaddad H. Occult Invasive Lobular Carcinoma Presenting as an Axillary Skin Metastatic Lesion Underwent Neoadjuvant Endocrine Therapy and Surgical Resection: A Case Report and Review of Literature. BREAST CANCER: TARGETS AND THERAPY 2022; 14:145-152. [PMID: 35669610 PMCID: PMC9166690 DOI: 10.2147/bctt.s366785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/23/2022] [Indexed: 11/23/2022]
Abstract
Introduction Invasive lobular carcinoma (ILC) is the second most common type of breast cancer accounting for 5–15% of all breast cancer cases. It usually presents with nonspecific signs and symptoms. Occult breast cancer presenting as an axillary mass is rare, with prevalence of 0.3–1%, less likely with isolated cutaneous breast metastasis as a first presentation. There are limited data in the literature on patients who underwent endocrine therapy and complete surgical resection. Case Presentation A 54-year-old woman with left axillary skin swelling that had been persisting for 6 years was diagnosed with ILC 18 months ago presenting with an ulcerated axillary skin lesion and was managed with letrozole in another facility as she was estrogen receptor (ER) and progesterone receptor (PR) positive. She received letrozole for 18 months and had a partial response in the form of healing of the ulcer with persistent subcutaneous nodules. Her breast mammogram, ultrasound, and magnetic resonance imaging findings were unremarkable; however, there were few prominent left axillary lymph nodes. A biopsy of the left axillary lymph node was positive for malignancy, consistent with ILC. A skin punch biopsy of the axillary skin lesion showed ILC extending to the dermis with no background breast tissue. The patient underwent left modified radical mastectomy with excision of the left axillary skin lesion. The breast specimen comprised 0.4 mm of ILC as the primary malignancy and nine positive axillary lymph node malignancies. The patient received adjuvant radiotherapy and continued to receive letrozole. There were no signs of complications or recurrence during the follow-up period. Conclusion Ulcerated skin lesions in the axilla should raise concerns regarding breast cancer metastasis. In cases of isolated cutaneous breast metastases, surgical excision can be considered in combination with endocrine therapy.
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Affiliation(s)
- Saleh Busbait
- Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
- Correspondence: Saleh Busbait, Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Al-Khobar, 31441, Saudi Arabia, Tel +966 138966666 Ext 1680, Fax +966 133330108, Email
| | - Abdullah M Alkhalifa
- Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Shahad Aljohani
- Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Hiyam Alhaddad
- Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
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Gruber I, Koelbl O. Dramatic radiotherapy response of a giant T4 cutaneous squamous cell carcinoma of the scalp with extensive bone destruction: a case report. J Med Case Rep 2021; 15:610. [PMID: 34952636 PMCID: PMC8709952 DOI: 10.1186/s13256-021-03213-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/29/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Patients with large cutaneous squamous cell carcinoma of the scalp are a treatment challenge. We report a case of dramatic radiotherapy response of a patient with a giant cutaneous squamous cell carcinoma of the scalp with extensive skull destruction and suspected infiltration of the dura mater and superior sagittal sinus. This case is the first report of this kind in the literature that shows that large bone defects can heal with the resolution of tumor and inflammation by secondary intention without surgical reconstruction. We want to put an end to concerns about radiocurability of tumors with extensive bone involvement, and show sustained complete response after definitive radiotherapy and programmed cell death protein-1 inhibiting antibody therapy. CASE PRESENTATION A 74-year-old White man presented with a 7.2 × 6.8 × 5.5 cm painless tumor on the right parietal region of the scalp. Medical imaging revealed widespread destruction of the skull and suspected infiltration of the dura mater and superior sagittal sinus. Biopsies showed cutaneous squamous cell carcinoma (cT4a cN0 cM0, stage IVA). The patient was treated with a total dose of 60 Gy, at 2 Gy per daily fraction with volumetric modulated arc therapy using 6 megavoltage photons. The biologically effective dose (alpha/beta 10 Gy) was 72 Gy. The tumor response correlated with dose received. The patient had a massive tumor necrosis secondary to tumor shrinkage after 18 fractions (36 Gy, biologically effective dose 43.2 Gy). Leakage of cerebrospinal fluid did not occur. Radiotherapy did not hamper the patient's quality of life. The patient had a clear regression of the initial tumor on the final day of radiotherapy. The bone defect healed by secondary intention without surgical interventions. The patient achieved a complete response with a good cosmetic result after 82 days follow-up. He started a programmed cell death protein-1 inhibiting antibody therapy with cemiplimab 2 months after radiotherapy, and is now at 10 months follow-up without evidence of recurrence. CONCLUSION Definitive radiotherapy is a safe and highly effective therapy for giant tumors of the scalp with extensive bone destruction. We report a sustained complete response with a good cosmetic result after secondary wound healing.
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Affiliation(s)
- Isabella Gruber
- Department of Radiation Oncology, University Hospital of University Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Oliver Koelbl
- Department of Radiation Oncology, University Hospital of University Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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14
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Dunaway S, Aggarwal P, Shaughnessy C, Neltner S. Surgical Surprise: Cutaneous Metastasis Presenting for Mohs Micrographic Surgery Without a Prior Diagnostic Biopsy. JMIR DERMATOLOGY 2021; 4:e33241. [PMID: 37632877 PMCID: PMC10334962 DOI: 10.2196/33241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Spencer Dunaway
- Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Pushkar Aggarwal
- University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Cristin Shaughnessy
- Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Scott Neltner
- Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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15
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Flanagan KE, Burns LJ, Pathoulas JT, Walker CJ, Pupo Wiss I, Cornejo KM, Senna MM. Primary Alopecia Neoplastica: A Novel Case Report and Literature Review. Skin Appendage Disord 2021; 7:499-509. [PMID: 34901185 PMCID: PMC8613616 DOI: 10.1159/000516650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/16/2021] [Indexed: 11/19/2022] Open
Abstract
Alopecia neoplastica (AN) is caused by neoplastic cells damaging hair follicles, resulting in patchy hair loss like cicatricial alopecia and alopecia areata. AN has predominantly described cutaneous metastasis to the scalp from primary visceral malignant tumors. Less frequently, AN results from a primary scalp neoplasm. Compared to "secondary AN," there is a paucity of literature on "primary AN." Herein, we present a comprehensive literature review of primary AN and introduce a unique case of amelanotic melanoma causing primary AN. Including our presented case, 11 cases of primary AN have been reported with causative scalp neoplasms including angiosarcoma, hemangioendothelioma, syringomatous carcinoma, ectopic extramammary Paget's disease, and primary desmoplastic melanoma. 27.3% (3 of 11) of cases were misdiagnosed and treated for a primary alopecia, and 36.4% (4 of 11) of lesions were present for multiple years or an unknown amount of time, likely due to difficulty in recognizing scalp lesion or misdiagnosis. All patients required surgical excision with 36.4% (4 of 11) requiring chemotherapy, radiation, or photodynamic therapy. Two patients with scalp angiosarcoma died from their aggressive disease. Due to the risks of malignant primary AN if allowed to progress, primary AN should be considered in patients presenting with scarring alopecia.
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Affiliation(s)
- Kelly E. Flanagan
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Laura J. Burns
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James T. Pathoulas
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Chloe J. Walker
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Isabel Pupo Wiss
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kristine M. Cornejo
- Dermatopathology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Maryanne M. Senna
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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16
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Venanzi Rullo E, Maimone MG, Fiorica F, Ceccarelli M, Guarneri C, Berretta M, Nunnari G. Non-Melanoma Skin Cancer in People Living With HIV: From Epidemiology to Clinical Management. Front Oncol 2021; 11:689789. [PMID: 34422644 PMCID: PMC8371466 DOI: 10.3389/fonc.2021.689789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/07/2021] [Indexed: 12/13/2022] Open
Abstract
Skin cancers represent the most common human tumors with a worldwide increasing incidence. They can be divided into melanoma and non-melanoma skin cancers (NMSCs). NMSCs include mainly squamous cell (SCC) and basal cell carcinoma (BCC) with the latest representing the 80% of the diagnosed NMSCs. The pathogenesis of NMSCs is clearly multifactorial. A growing body of literature underlies a crucial correlation between skin cancer, chronic inflammation and immunodeficiency. Intensity and duration of immunodeficiency plays an important role. In immunocompromised patients the incidence of more malignant forms or the development of multiple tumors seems to be higher than among immunocompetent patients. With regards to people living with HIV (PLWH), since the advent of combined antiretroviral therapy (cART), the incidence of non-AIDS-defining cancers (NADCs), such as NMSCs, have been increasing and now these neoplasms represent a leading cause of illness in this particular population. PLWH with NMSCs tend to be younger, to have a higher risk of local recurrence and to have an overall poorer outcome. NMSCs show an indolent clinical course if diagnosed and treated in an early stage. BCC rarely metastasizes, while SCC presents a 4% annual incidence of metastasis. Nevertheless, metastatic forms lead to poor patient outcome. NMSCs are often treated with full thickness treatments (surgical excision, Mohs micro-graphic surgery and radiotherapy) or superficial ablative techniques (such as cryotherapy, electrodesiccation and curettage). Advances in genetic landscape understanding of NMSCs have favored the establishment of novel therapeutic strategies. Concerning the therapeutic evaluation of PLWH, it’s mandatory to evaluate the risk of interactions between cART and other treatments, particularly antiblastic chemotherapy, targeted therapy and immunotherapy. Development of further treatment options for NMSCs in PLWH seems needed. We reviewed the literature after searching for clinical trials, case series, clinical cases and available databases in Embase and Pubmed. We review the incidence of NMSCs among PLWH, focusing our attention on any differences in clinicopathological features of BCC and SCC between PLWH and HIV negative persons, as well as on any differences in efficacy and safety of treatments and response to immunomodulators and finally on any differences in rates of metastatic disease and outcomes.
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Affiliation(s)
- Emmanuele Venanzi Rullo
- Unit of Infectious Disease, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria Grazia Maimone
- Unit of Infectious Disease, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Fiorica
- Department of Radiation Oncology and Nuclear Medicine, State Hospital "Mater Salutis" Azienda Unità Locale Socio Sanitaria (AULSS) 9, Legnago, Italy
| | - Manuela Ceccarelli
- Unit of Infectious Disease, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Unit of Infectious Disease, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Claudio Guarneri
- Unit of Dermatology, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Massimiliano Berretta
- Unit of Infectious Disease, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Nunnari
- Unit of Infectious Disease, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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17
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Chlebicka I, Stefaniak AA, Gawdzik A, RygaŁ A, Matusiak Ł, Szepietowski JC. Scalp Lesions Referred For Surgical Procedures: Single-Center 5-year Experience in Southwestern Poland. In Vivo 2021; 34:2733-2738. [PMID: 32871807 DOI: 10.21873/invivo.12095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/15/2020] [Accepted: 05/06/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND/AIM The head is a body site with a particular predisposition to skin malignancies due to exposure to UV radiation. The aim of the study was to better elucidate the characteristics of skin lesions that develop on the scalp. PATIENTS AND METHODS A retrospective review of all excised and histologically assessed lesions of the scalp at a single dermatosurgery unit throughout a five-year period was performed. Demographic features and lesion characteristics were compiled and analyzed. RESULTS Among 5,601 procedures during the analyzed period, 293 were performed on lesions on the scalp area (5.2%) with a mean patient age of 66±19.7 years. The defects were closed, mainly using primary closure, followed by skin grafts, and, least often, flaps (65.1%, 28.5%, 4.9%, respectively). Two thirds of the excised scalp lesions were histologically confirmed as malignant scalp tumors (mostly basal cell carcinomas followed by squamous cell carcinomas). CONCLUSION The vast majority of scalp lesions referred for surgical procedures appeared to be malignant. Therefore, dermatologists should pay special attention to the scalp by examining it thoroughly, as the lesions may be hidden by hair.
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Affiliation(s)
- Iwona Chlebicka
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
| | - Aleksandra A Stefaniak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
| | - Anna Gawdzik
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
| | - Alicja RygaŁ
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
| | - Łukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
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18
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Kawaguchi M, Kato H, Suzui N, Miyazaki T, Tomita H, Hara A, Matsuyama K, Seishima M, Matsuo M. Imaging findings of cutaneous angiosarcoma of the scalp: Comparison with cutaneous squamous cell carcinoma. Neuroradiol J 2021; 34:329-334. [PMID: 33657921 DOI: 10.1177/1971400921998941] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE This study aimed to evaluate imaging findings of cutaneous angiosarcoma (cAS) of the scalp compared with those of cutaneous squamous cell carcinoma (cSCC). METHODS This study included 15 patients with primary cAS and 10 with primary cSCC of the scalp. Seven patients with cAS and eight with cSCC underwent magnetic resonance imaging, and 11 patients with cAS and eight with cSCC underwent 18F-fluorodeoxyglucose-positron emission tomography/computed tomography imaging. Imaging findings for both pathologies were retrospectively reviewed and compared. RESULTS All 15 cAS cases were elevated lesions with an obtuse angle, invading the subcutaneous fat tissue. Multiple lesions were observed in only five cAS cases (33%) and no cSCC cases. Maximum diameter-to-height ratio was significantly higher in cAS than in cSCC (3.3 ± 1.0 versus 2.3 ± 0.6; p < 0.01). On T2-weighted images, intratumoral hypointensity (86% versus 13%; p < 0.01) and mixed hyper- and hypointensity (71% versus 0%; p < 0.01) were observed more frequently in cAS than in cSCC. No significant differences were observed between cAS and cSCC regarding flow void (29% versus 25%; p = 0.656). Maximum standardized uptake values were marginally significantly lower in cAS than in cSCC (5.6 ± 3.1 versus 10.5 ± 6.6; p = 0.078). CONCLUSIONS Cases of cAS of the scalp always exhibited flat elevated lesions with invasion of the subcutaneous fat tissue. Compared with cSCC, intratumoral hypointensity and mixed hyper- and hypointensity on T2-weighted images were more frequent in cAS. These findings will help with the differential diagnosis of cAS.
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Affiliation(s)
| | - Hiroki Kato
- Department of Radiology, Gifu University, Japan
| | | | | | | | - Akira Hara
- Department of Tumor Pathology, Gifu University, Japan
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19
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Multimodality imaging and treatment strategy for malignant scalp neoplasms in adults. Clin Imaging 2021; 77:48-57. [PMID: 33640791 DOI: 10.1016/j.clinimag.2021.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 12/30/2020] [Accepted: 02/21/2021] [Indexed: 11/22/2022]
Abstract
Malignant scalp masses deserve much attention as they have the potential to destroy local structures, recur and metastasize to distant organs. Moreover, malignant scalp lesions are known to be more aggressive in behavior than their counterparts elsewhere in the body. Multimodality imaging is essential in narrowing the differential diagnoses of scalp masses, as well as in differentiating benign from malignant masses. Furthermore, imaging is important in (1) evaluating the extent of tumor invasion in the scalp, (2) staging the disease, (3) guiding surgical biopsy and/or resection of the tumor, (4) preoperative planning and post-treatment surveillance of scalp tumors. An interdisciplinary treatment approach is crucial for the management of scalp malignancies given their complex and aggressive nature. This review seeks to describe the unique clinical and imaging characteristics of various types of malignant scalp masses, as well as to review their current treatment strategies.
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20
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Griepp DW, Sajan A, Sighary M, Grigorian A. Adnexal carcinoma of the scalp: aggressive sebaceous differentiation with invasion of the orbital wall and thoracic vertebra. Clin Imaging 2021; 77:147-150. [PMID: 33684788 DOI: 10.1016/j.clinimag.2021.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/22/2020] [Accepted: 01/30/2021] [Indexed: 11/16/2022]
Abstract
Tumors of the scalp are characterized by a heterogeneous clinical spectrum with site-specific features. A wide variety of tumors that arise in the scalp include neoplasms, hamartomas, malformations, and both benign and malignant cysts. Most scalp tumors are benign (98-99%) with only an estimated 1-2% of diagnosed cases reported as being malignant. Of these, adnexal carcinoma is reported in less than 1% of cases. Herein, we report a 65-year-old woman who presented with pain and numbness in her hands with past medical history significant only for a chronic posterior head mass that had never received workup. Computerized topography (CT), magnetic resonance imaging (MRI), and local biopsy demonstrated a large, pedunculated malignant occipital mass that had metastasized to the orbital walls and cervical spine. To our knowledge, this is the largest sebaceous carcinoma to be reported occurring in the scalp. The present case emphasizes the need for older patients with benign scalp lesions to be closely monitored with frequent CT scans for signs of malignant transformation. Furthermore, it is important to diagnose malignant scalp tumors early as they tend to metastasize and cause diffuse symptomatology, which may ultimately result in increased patient mortality.
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Affiliation(s)
- Daniel W Griepp
- College of Medicine, New York Institute of Technology, 101 Northern Blvd, Old Westbury, NY, USA; Department of Radiology, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, USA
| | - Abin Sajan
- Department of Surgery, NYU Langone Hospital - Long Island, Mineola, 249 1st Street, Mineola, NY, USA.
| | - Maziar Sighary
- Department of Radiology, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, USA
| | - Arkadij Grigorian
- Department of Radiology, NYU Langone Hospital, 550 1st Ave, New York, NY, USA
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21
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Suk S, Shin HW, Yoon KC, Kim J. Aggressive cutaneous squamous cell carcinoma of the scalp. Arch Craniofac Surg 2020; 21:363-367. [PMID: 33663145 PMCID: PMC7933721 DOI: 10.7181/acfs.2020.00381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/19/2020] [Indexed: 11/11/2022] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common nonmelanoma skin cancer, and its incidence is increasing globally. In Korea, there were 12,516 diagnosed cases of cSCC between 1999 and 2014. Surgical treatment, for which several options are available, is the standard of care for cSCC and securing a sufficient surgical resection margin is always important. cSCC of the scalp sometimes exhibits unusually aggressive behavior. In this article, we report a case of cSCC of the scalp with invasion into the skull and dura mater.
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Affiliation(s)
- Sangwoo Suk
- Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Woo Shin
- Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kun Chul Yoon
- Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Junekyu Kim
- Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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22
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Gupta M, Yekula A, Sagi V, Mittal A, Schwartz MS. Squamous cell carcinoma of the scalp causing cortical venous thrombosis and Intraparenchymal hematoma. eNeurologicalSci 2020; 20:100251. [PMID: 32613095 PMCID: PMC7317240 DOI: 10.1016/j.ensci.2020.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/26/2020] [Accepted: 06/12/2020] [Indexed: 11/29/2022] Open
Abstract
We present a case of squamous cell carcinoma causing cortical venous thrombosis (CoVT) This is the first case of an invasive scalp lesion causing CoVT and brain hemorrhage Some cases of CoVT may be managed conservatively Recurrent, invasive squamous cell carcinoma remains therapeutically challenging
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Affiliation(s)
- Mihir Gupta
- Department of Neurosurgery, University of California San Diego. La Jolla, CA, USA
| | - Anudeep Yekula
- Department of Neurosurgery, Massachusetts General Hospital. Boston, MA, USA
| | - Varun Sagi
- School of Medicine, University of Minnesota Twin Cities. Minneapolis, MN, USA
| | - Aditya Mittal
- School of Medicine, University of Pittsburgh. Pittsburgh, PA, USA
| | - Marc S Schwartz
- Department of Neurosurgery, University of California San Diego. La Jolla, CA, USA
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23
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Liu YF, Liu LY, Xia SL, Li T, Li J. An Unusual Case of Scalp Metastasis from Breast Cancer. World Neurosurg 2020; 137:261-265. [PMID: 32035211 DOI: 10.1016/j.wneu.2020.01.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The most common sites of breast cancer metastases are the bone, lung, liver, and brain. Scalp involvement in breast cancer metastasis is extraordinarily rare. CASE DESCRIPTION This study reports a 52-year-old woman who had a history of malignant right breast cancer and underwent a mastectomy. Positron emission tomography/computed tomography revealed a soft tissue nodule measuring 1 × 0.7 cm located subcutaneously on the top left side of the scalp. A scalp mass excision operation was performed with an extended "S"-shaped incision, and the mass was sent for pathology. Immunohistochemistry showed the following results: CK7: +; ER: 2+, 90%; GATA3: +; GCDFP-15: scattered cells+; mammaglobin: -, napsin A: -; and TTF-1: -. These results were consistent with the characteristics of primary right breast cancer, supporting scalp metastasis from breast cancer. CONCLUSIONS Scalp metastasis from breast cancer is an exceedingly infrequent phenomenon. Close attention should be paid to soft tissue masses in patients with a healthy appearance and in those with a history of malignant cancer. When neurosurgeons operate on the mass, the circumscription and depth of the tumor must be given further attention.
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Affiliation(s)
- Yu-Fei Liu
- Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China; Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ling-Yu Liu
- Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shi-Lin Xia
- Clinical Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; Department of Palliative Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Tao Li
- Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
| | - Jun Li
- Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Abstract
RATIONALE The prognosis of lung cancer is dismal, which has resulted in lung carcinoma being one of the leading causes of cancer-related deaths worldwide. Non-small cell lung cancer accounts for approximately 80% of all types of lung carcinoma. The skeletal system and central nervous system are the most common distal metastatic sites in patients with lung cancer, while cutaneous and soft tissues metastasis is rare. PATIENT CONCERNS We report a case of concomitant metastasis in the nasal tip and suspected buttocks metastasis secondary to lung cancer, who complained of repeated cough and white sputum for 6 months. DIAGNOSE Primary lung cancer was diagnosed by bronchoscopy and biopsy, lesion on nasal tip was confirmed by biopsy. Furthermore, PET-CT scan identified the untouchable buttocks lesion that could have been easily missed. INTERVENTIONS This patient refused systemic treatments, but he chose traditional Chinese medicine at home. OUTCOMES He died 6 months after the diagnosis. LESSONS The possibility of metastasis of primary cancers should be considered when encountering soft-tissue neoplasm lesions, and a biopsy of the suspicious cutaneous lesions could likely aid in the histological identification of the primary cancer. PET-CT scan could be an effective supplementary tool for the diagnosis and evaluation of cancers.
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Affiliation(s)
| | - Jialu Chen
- Department of Gynaecology, Women's & Children's Hospital of Haining city
| | - Fanfan Yang
- Department of Pathology, People's Hospital of Haining city, Haining, Zhejiang province, China
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25
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Diop A, Diallo M, Ndiaye MT, Seck B, Diadie S, Diatta BA, Ndiaye M, Baidouri Z, Deme A, Ly F, Niang SO, Kane A, Dieng MT. [Epidemiological and anatomoclinical features of scalp tumors in black Africans]. Pan Afr Med J 2019; 34:98. [PMID: 31934241 PMCID: PMC6945662 DOI: 10.11604/pamj.2019.34.98.18123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 08/14/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Au Sénégal, les études portant sur les tumeurs du cuir chevelu sont quasi inexistantes. Notre objectif était de déterminer le profil épidémiologique et anatomo-clinique des tumeurs du cuir chevelu en dermatologie. Méthodes Il s'agit d'une étude prospective, descriptive et analytique, réalisée sur une période de 16 mois (01 mars 2014 au 30 juin 2015), effectuée aux deux services de dermatologie de Dakar. La confirmation diagnostique était histopathologique. Résultats Nous avions colligé 36 patients dont 14 cas de tumeurs malignes et 22 cas de tumeurs bénignes. Le sex ratio était de 1:1, et l'âge moyen de 51 ans pour les premières et 39 ans pour les dernières. La fréquence hospitalière était de 0,18%. Le délai moyen de consultation était de 14 mois pour les tumeurs malignes et 52 mois pour les formes bénignes. Dans 11 cas de tumeurs malignes, le traitement traditionnel était le premier recours. Les tumeurs malignes étaient: carcinome épidermoïde (n=8), carcinome basocellulaire (n=3), lymphome, hidradénocarcinome et dermatofibrosarcome de Darier Ferrand (un cas chacun). Les tumeurs bénignes étaient: botriomycome (n=5), kyste trichilemmal, hamartome sébacé, cylindrome et lipome (2 cas chacun), et chéloide, syringocystadénome papillifère, schwannome, neurofibrome et nævus (un cas chacun). La malignité de la tumeur était associée à l'aspect ulcéro-bourgeonnant (p=0.003), au diamètre >4cm (p=0.05), à la douleur (p=0.009) et au saignement (p=0.006). Conclusion Les tumeurs du cuir chevelu, sur peau noire, sont dominées par les formes bénignes. Le carcinome épidermoïde est la tumeur maligne prédominante.
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Affiliation(s)
- Assane Diop
- Dermatologie Hôpital Institut d'Hygiène Sociale de Dakar, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | - Moussa Diallo
- Dermatologie Hôpital Aristide Le Dantec, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | - Mame Tene Ndiaye
- Dermatologie Hôpital Institut d'Hygiène Sociale de Dakar, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | - Biram Seck
- Dermatologie Hôpital Institut d'Hygiène Sociale de Dakar, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | - Saer Diadie
- Dermatologie Hôpital Aristide Le Dantec, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | - Boubacar Ahy Diatta
- Dermatologie Hôpital Aristide Le Dantec, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | - Maodo Ndiaye
- Dermatologie Hôpital Aristide Le Dantec, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | - Zineb Baidouri
- Dermatologie Hôpital Institut d'Hygiène Sociale de Dakar, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | - Ahmadou Deme
- Institut Curie Hôpital Aristide Le Dantec, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | - Fatimata Ly
- Dermatologie Hôpital Institut d'Hygiène Sociale de Dakar, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | - Suzanne Oumou Niang
- Dermatologie Hôpital Aristide Le Dantec, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | - Assane Kane
- Dermatologie Hôpital Aristide Le Dantec, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | - Mame Thierno Dieng
- Dermatologie Hôpital Aristide Le Dantec, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
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Is Three-Dimensional Virtual Planning in Cranial Reconstruction for Advanced Cutaneous Squamous Cell Carcinoma of the Skull a Feasible Option? J Craniofac Surg 2019; 30:2362-2367. [PMID: 31609941 DOI: 10.1097/scs.0000000000005895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (cSCC) is a common type of malignant skin disorder. An uncommon feature is local bony invasion, as can rarely be seen in lesions on the scalp. The optimal treatment strategy in these rare cases is still under debate. OBJECTIVE The aim of this case report is to present a 1-stage three-dimensional planned surgical resection and reconstruction of a cSCC with bony invasion into the scalp and to discuss the alternative options and potential pitfalls. MATERIALS AND METHODS A patient diagnosed with rT4N0M0 cSCC of the scalp underwent a cranial resection and reconstruction in 1 stage. With the use of computer-assisted design and computer-assisted manufacturing a patient-specific implant (PSI) of poly (ether ether ketone) was manufactured. After the PSI was inserted, it was covered with a latissimus dorsi muscle and a split-thickness skin graft. RESULTS Intraoperatively the resection template generated an accurate resection and accurate and fast placement of the PSI. The reconstruction had a clinical satisfactory esthetic result, but was hampered by the development of a small wound dehiscence was observed over the postoperative course. CONCLUSION Three-dimensional planned resection and reconstruction for composite defects of the skull after resection of a cSCC of the scalp with bony invasion may lead to an accurate and predictable resection and accurate and fast placement of the PSI. However, patient specific characteristics should be considered to assess potential risks and benefits before opting for this one-stage treatment strategy.
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Kawaguchi M, Kato H, Matsuo M. CT and MRI features of scalp lesions. Radiol Med 2019; 124:1049-1061. [DOI: 10.1007/s11547-019-01060-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 06/24/2019] [Indexed: 12/22/2022]
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Paolino G, Pampena R, Grassi S, Mercuri SR, Cardone M, Corsetti P, Moliterni E, Muscianese M, Rossi A, Frascione P, Longo C. Alopecia neoplastica as a sign of visceral malignancies: a systematic review. J Eur Acad Dermatol Venereol 2019; 33:1020-1028. [PMID: 30767283 DOI: 10.1111/jdv.15498] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 01/18/2019] [Indexed: 12/11/2022]
Abstract
Alopecia neoplastica (AN) from visceral tumours is a rare form of cutaneous metastasis in which internal malignancies spread to the scalp. The diagnosis of AN may be very challenging, especially when its onset precedes the diagnosis of the primary tumour. We aimed to improve the knowledge on AN, highlighting that in case of scarring localized alopecia, a differential diagnosis with metastasis should always be considered. We performed a systematic review to describe the main demographic and clinical features associated with AN from visceral malignancies; a survival analysis was also performed. In 118 reports, accounting for 123 patients, we found that women were more affected by AN than men (53.7% vs. 46.3%). The most frequent site of the primary tumour was the gastrointestinal tract (24.4%), followed by breast (17.9%), kidney (8.1%), lung (7.3%), thyroid (7.3%), uterus (6.5%), central nervous system (6.5%), liver (3.3%) and other anatomic areas for 18.7% of cases. Furthermore, in more than half of the cases (66.1%), AN lesions were single and were mainly diagnosed after the primary visceral tumour (71.5%). Finally, survival analysis highlighted a lower progression-free survival in men; while, no significant differences in overall survival were reported among genders. In conclusion, metastatic skin disease should always be taken into consideration when dealing with patients with localized scarring alopecia.
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Affiliation(s)
- G Paolino
- Dermatology and Cosmetology, IRCCS San Raffaele Hospital, Milan, Italy.,Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | - R Pampena
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - S Grassi
- Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | - S R Mercuri
- Dermatology and Cosmetology, IRCCS San Raffaele Hospital, Milan, Italy
| | - M Cardone
- Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | - P Corsetti
- Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | - E Moliterni
- Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | - M Muscianese
- Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | - A Rossi
- Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | - P Frascione
- Department of Oncological and Preventative Dermatological, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - C Longo
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Dermatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy
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29
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Alizadeh N, Mirpour H, Azimi SZ. Scalp metastasis from occult primary breast carcinoma: A case report and review of the literature. Int J Womens Dermatol 2018; 4:230-235. [PMID: 30627623 PMCID: PMC6322159 DOI: 10.1016/j.ijwd.2018.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 07/15/2018] [Accepted: 08/07/2018] [Indexed: 01/13/2023] Open
Abstract
Background Isolated distant cutaneous metastasis of breast carcinoma is uncommon. Furthermore, isolated metastasis of the scalp seems to be very rare in breast cancer. Case presentation A 44-year-old woman was referred to our dermatology department with concerns of a firm, painless, immobile, hardened, skin-colored mass fixed to the underlying tissues. The lesion measured 2 to 3 cm on the scalp frontalis without regional or distant lymphadenopathy. The patient had a history of benign right breast biopsy test results. Immunohistochemistry test results were positive for cytokeratin (AE1/AE3), cytokeratin 7, chromogranin, estrogen receptor, and gross cystic disease fluid protein-15; group PR/HER2 were both weakly positive. Cytokeratin 20, thyroid-lung transcription factor, S100 protein, vimentin and thyroglobulin were all negative. Pathology test results showed adenocarcinoma that was consistent with breast primary. Conclusion Although cutaneous metastasis of the chest wall due to breast carcinoma is a common condition, scalp metastasis as the first sign of occult breast cancer is an extremely rare condition. We describe an isolated scalp metastasis as the initial presentation of breast cancer in a young woman in this report, which highlights that health care providers should be alert to the possibility that atypical soft tissue masses may represent a neoplasm. Further consideration of the scalp lesions among healthy looking patients is recommended.
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Affiliation(s)
- N Alizadeh
- Skin Research Center, Department of Dermatology, Razi hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - H Mirpour
- Department of Hematology and Oncology, Razi hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - S Z Azimi
- Skin Research Center, Department of Dermatology, Razi hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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30
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Prodinger CM, Koller J, Laimer M. Scalp tumors. J Dtsch Dermatol Ges 2018; 16:730-753. [DOI: 10.1111/ddg.13546] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 04/10/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Christine Maria Prodinger
- Department of Dermatology; Salzburg Regional Medical Center; Paracelsus Medical University; Salzburg Austria
| | - Josef Koller
- Department of Dermatology; Salzburg Regional Medical Center; Paracelsus Medical University; Salzburg Austria
| | - Martin Laimer
- Department of Dermatology; Salzburg Regional Medical Center; Paracelsus Medical University; Salzburg Austria
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31
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Prodinger CM, Koller J, Laimer M. Tumoren der Kopfhaut. J Dtsch Dermatol Ges 2018; 16:730-754. [DOI: 10.1111/ddg.13546_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 04/10/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Christine Maria Prodinger
- Universitätsklinik für Dermatologie; Salzburger Landesklinken - Uniklinikum der Paracelsus Medizinischen Privatuniversität Salzburg; Österreich
| | - Josef Koller
- Universitätsklinik für Dermatologie; Salzburger Landesklinken - Uniklinikum der Paracelsus Medizinischen Privatuniversität Salzburg; Österreich
| | - Martin Laimer
- Universitätsklinik für Dermatologie; Salzburger Landesklinken - Uniklinikum der Paracelsus Medizinischen Privatuniversität Salzburg; Österreich
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32
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Jose N, Isac CM, Kunjumani S, Vilasiniamma L. Sarcomatoid lung carcinoma presenting as alopecia neoplastica. Indian J Dermatol Venereol Leprol 2018; 84:188-190. [PMID: 29327696 DOI: 10.4103/ijdvl.ijdvl_959_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Naveena Jose
- Department of Dermatology and Venereology, Government Medical College, Kottayam, Kerala, India
| | | | - Sobhanakumari Kunjumani
- Department of Dermatology and Venereology, Government Medical College, Kottayam, Kerala, India
| | - Letha Vilasiniamma
- Department of Pathology, Government Medical College, Kottayam, Kerala, India
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Scalp metastasis as an initial presentation of lung adenocarcinoma : A case report and literature review. Int J Surg Case Rep 2017; 41:327-331. [PMID: 29136605 PMCID: PMC5683037 DOI: 10.1016/j.ijscr.2017.10.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/29/2017] [Indexed: 11/23/2022] Open
Abstract
A careful skin examination can provide valuable clues to internal malignancy. Solitary scalp metastasis as the first sign of an occult non-small-cell lung cancer is an extremely rare occurrence. Despite its rarity, metastatic skin disease should always be considered in the differential diagnosis in patients with a history of smoking or lung cancer presenting with cutaneous nodules. Increased awareness of this rare entity is needed for early recognition and initiation of the appropriate treatment. Moreover, it helps in appropriate staging, altering therapy and a better estimation of prognosis. We also conclude that a cutaneous metastases is the most common dermatological manifestation of lung cancer.
Introduction Cutaneous metastasis from primary visceral malignancy is a relatively uncommon clinical entity, with a reported incidence of 0.22%–10% among various series. However, the presence of cutaneous metastasis as the first sign of a clinically silent visceral cancer is exceedingly rare. Presentation of case We describe here a case of an asymptomatic male patient who presented with a solitary scalp metastasis as the initial manifestation of an underlying lung cancer. Diagnostic evaluation revealed advanced disease. Discussion The report emphasizes that physicians should be aware of this rare clinical entity, and appropriate investigation should be arranged for early diagnosis and initiation of the appropriate treatment. The occurrence of skin lesions in lung cancer announces an ominous prognosis. Conclusion We conclude that the possibility of metastatic skin disease should always be considered in the differential diagnosis in patients with a history of smoking or lung cancer presenting with cutaneous nodules.
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34
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Weimann ETDS, Botero EB, Mendes C, Santos MASD, Stelini RF, Zelenika CRT. Cutaneous metastasis as the first manifestation of occult malignant breast neoplasia. An Bras Dermatol 2017; 91:105-107. [PMID: 28300911 PMCID: PMC5325010 DOI: 10.1590/abd1806-4841.20164572] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/27/2015] [Indexed: 11/22/2022] Open
Abstract
Cutaneous metastases from primary internal malignancies represent 0.7-9% of
patients with cancer. We report a 65-year-old female patient referred for
evaluation of normochromic papules on the trunk and upper limbs that had been
present for three months. A skin biopsy revealed diffuse cutaneous infiltration
by small round cell tumors. Immunohistochemistry was positive for AE1/AE3, CK7,
estrogen receptor and mammaglobin. The final diagnosis was cutaneous metastasis
of occult breast cancer, since the solid primary tumor was not identified. The
location of the primary tumor can not be determined in 5-10% of cases. In these
cases, 27% are identified before the patient’s death, 57% at autopsy, and the
remaining 16% can not be located.
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35
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Handler MZ, Goldberg DJ. Cutaneous squamous cell carcinoma of the scalp extending to the skull: A case report and review of the literature. J Cosmet Dermatol 2017; 17:232-234. [DOI: 10.1111/jocd.12378] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Marc Z Handler
- Skin Laser & Surgery Specialists of NY and NJ; Hackensack NJ USA
- Dermatology; Rutgers University New Jersey Medical School; Newark NJ USA
| | - David J Goldberg
- Skin Laser & Surgery Specialists of NY and NJ; Hackensack NJ USA
- Dermatology; Rutgers University New Jersey Medical School; Newark NJ USA
- Department of Dermatology; Icahn School of Medicine at Mt. Sinai; New York NY USA
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36
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Wang F, Tong ZH. Cutaneous Metastasis as the First Symptom: An Uncommon Presentation of Squamous Cell Lung Cancer. Chin Med J (Engl) 2017; 130:115-116. [PMID: 28051036 PMCID: PMC5221103 DOI: 10.4103/0366-6999.196584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Feng Wang
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing 100020, China
| | - Zhao-Hui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing 100020, China
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37
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Shirley BM, Kang DR, Sakamoto AH. Malignant Solitary Fibrous Tumor of the Scalp. J Maxillofac Oral Surg 2016; 15:245-8. [PMID: 27408445 DOI: 10.1007/s12663-015-0759-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 02/16/2015] [Indexed: 01/21/2023] Open
Abstract
Solitary fibrous tumors are an uncommon slow growing benign neoplasm originally described as a pleural neoplasm but can also be found in the lung, mediastinum, peritoneum, or any other sites including the head and neck. Malignant solitary fibrous tumors (MSFT) are extremely rare and only few cases have been published in the literature. There have been 19 cases reported of MSFT in the head and neck, but there are no reports of MSFT located within the scalp in the English language literature. We present a case of MSFT arising in the scalp and describe our experience with the clinical presentation, surgical management, and outcome in this pathological condition.
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Affiliation(s)
- Brett M Shirley
- Oral and Maxillofacial Surgery Division, Department of Surgery, Parkland Memorial Hospital, University of Texas Southwestern Medical Center at Dallas, Dallas, TX USA ; Oral and Maxillofacial Surgery Department, John Peter Smith Hospital, 1500 S Main, Fort Worth, TX 76104 USA
| | - David R Kang
- Department of Oral and Maxillofacial Surgery, Texas A&M University Baylor College of Dentistry, Dallas, TX USA ; Department of Surgery, Division of Surgical Oncology, Baylor University Medical Center, 3302 Gaston Ave, Dallas, TX 75246 USA
| | - Aya Hamao Sakamoto
- Oral and Maxillofacial Surgery Division, Department of Surgery, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-9109 USA
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38
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Taguchi S, Ogawa T, Takayashiki N, Katayama K, Satoh H. Isolated squamous cell lung cancer metastasis to the scalp. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2015.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Schulman JM, Pauli ML, Neuhaus IM, Sanchez Rodriguez R, Taravati K, Shin US, McCalmont TH, Rosenblum MD. The distribution of cutaneous metastases correlates with local immunologic milieu. J Am Acad Dermatol 2016; 74:470-6. [PMID: 26778012 DOI: 10.1016/j.jaad.2015.10.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/20/2015] [Accepted: 10/21/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Metastases to the skin are found with increased frequency at certain sites, such as the scalp, but the biological factors that influence this distribution are not understood. OBJECTIVE We aimed to compare the proportional frequency of metastases at various cutaneous locations with the immunologic microenvironments at those sites. METHODS We retrospectively identified all biopsy specimens of cutaneous metastases diagnosed at our institution from 1991 to 2014 (n = 1984) and mapped their anatomic distribution while controlling for regional surface area. Using a separate, mapped cohort of normal-appearing skin samples (n = 140), we measured the density of regulatory T cells, CD4(+) effector T cells, and CD8(+) T cells by flow cytometry. RESULTS Per unit surface area, cutaneous metastases arise most commonly on the head and neck, followed by the trunk, upper extremities, and lower extremities, respectively. Sites with more frequent metastases tend to contain a greater density of regulatory T cells and a lower proportion of CD8(+) T cells (P < .05). LIMITATIONS Immunologic factors were only assessed in control tissue and were not measured from patients with metastatic disease in this correlative single-center study. CONCLUSION The distribution of cutaneous metastases follows the distribution of regulatory and effector T cells in skin. Further studies are required to prove a mechanistic association between local immunologic factors and the development of cutaneous metastases.
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Affiliation(s)
- Joshua M Schulman
- Department of Dermatology, University of California, San Francisco, California; Department of Pathology, University of California, San Francisco, California
| | - Mariela L Pauli
- Department of Dermatology, University of California, San Francisco, California
| | - Isaac M Neuhaus
- Department of Dermatology, University of California, San Francisco, California
| | | | - Keyon Taravati
- Department of Dermatology, University of California, San Francisco, California
| | - Uk Sok Shin
- Department of Dermatology, University of California, San Francisco, California
| | - Timothy H McCalmont
- Department of Dermatology, University of California, San Francisco, California; Department of Pathology, University of California, San Francisco, California
| | - Michael D Rosenblum
- Department of Dermatology, University of California, San Francisco, California.
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40
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Abstract
Cutaneous metastasis from primary visceral malignancy is a relatively uncommon clinical entity, with a reported incidence ranging from 0.22% to 10% among various series. However, the presence of cutaneous metastasis as the first sign of a clinically silent visceral cancer is exceedingly rare. We describe here a case of an asymptomatic male patient who presented with a solitary scalp metastasis as the initial manifestation of an underlying small-cell lung cancer. Diagnostic evaluation revealed advanced disease. We conclude that the possibility of metastatic skin disease should always be considered in the differential diagnosis in patients with a history of smoking or lung cancer presenting with cutaneous nodules. Physicians should be aware of this rare clinical entity, and appropriate investigation should be arranged for early diagnosis and initiation of the appropriate treatment. The prognosis for most patients remains poor.
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41
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Lippert DC, Britt CJ, Pflum ZE, Rush PS, Hartig GK. Metastatic synovial sarcoma of the scalp: Case report. Head Neck 2015; 38:E45-8. [DOI: 10.1002/hed.24122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2015] [Indexed: 01/22/2023] Open
Affiliation(s)
- Dylan C. Lippert
- Department of Otolaryngology; University of Wisconsin-Madison; Madison Wisconsin
| | - Christopher J. Britt
- Department of Otolaryngology; University of Wisconsin-Madison; Madison Wisconsin
| | - Zachary E. Pflum
- Department of Otolaryngology; University of Wisconsin-Madison; Madison Wisconsin
| | - Patrick S. Rush
- Department of Pathology and Laboratory Medicine; University of Wisconsin-Madison; Madison Wisconsin
| | - Gregory K. Hartig
- Department of Otolaryngology; University of Wisconsin-Madison; Madison Wisconsin
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DU C, Hong R, Liu Y, Wang J, Zhang H, Yu X. Scalp metastasis from gastric cancer: A case report and literature review. Oncol Lett 2014; 9:641-644. [PMID: 25624893 PMCID: PMC4301561 DOI: 10.3892/ol.2014.2708] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 01/02/2014] [Indexed: 11/24/2022] Open
Abstract
The current report presents an extremely rare case of a 41-year-old female with advanced gastric cancer who developed scalp metastasis during the period of systemic chemotherapy. The patient did not exhibit any rash or plaque at the initial physical examination. Following the 11th cycle of chemotherapy, the patient complained of pain on the scalp and a pink lesion was identified in the parietal region on physical examination, which increased in size and became darker and ulcerated. Pathological biopsy of the lesion and cranial magnetic resonance imaging confirmed the diagnosis of scalp metastasis. The patient succumbed to the disease one month later. The English literature was searched in the PubMed database and four cases of gastric cancer metastatic to the scalp were found. The present report discusses the common clinical presentations of these four cases in combination with the current case.
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Affiliation(s)
- Chunxia DU
- Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences, Beijing 100021, P.R. China
| | - Ruoxi Hong
- Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences, Beijing 100021, P.R. China
| | - Yuehua Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Jinwan Wang
- Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences, Beijing 100021, P.R. China
| | - Honggang Zhang
- Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences, Beijing 100021, P.R. China
| | - Xiaoduo Yu
- Department of Radiology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences, Beijing 100021, P.R. China
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[Tumors of the scalp: special aspects of selected examples]. Hautarzt 2014; 65:1030-6. [PMID: 25315428 DOI: 10.1007/s00105-014-3531-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Tumors of the scalp display some clinical, histological and prognostic characteristics. Early recognition of tumors is hampered by dense hair growth which can result in delayed diagnosis. MATERIAL AND METHODS Taking current literature into consideration atypical fibroxanthoma, cutaneous angiosarcoma, melanoma of the scalp, some adnexal tumors including the proliferating trichilemmal tumor as well as cutaneous metastases from visceral malignancies will be discussed. RESULTS Based on the fact that early scalp tumors are clinically difficult to recognize, they are often diagnosed at a late stage. Angiosarcomas belong to the most aggressive skin tumors and show a rapid growth with unfavorable prognosis. Malignant melanoma on the head has a more serious prognosis in comparison to other locations of the body. Cutaneous metastases are mostly a sign of an advanced tumor stage with a fatal prognosis. The various types of adnexal tumors are mostly benign. In exceptional cases rapid growth and ulceration may be an indicator for the development of an adnexal carcinoma. On the scalp tumors with sweat gland differentiation are more frequent than tumors with follicular differentiation. This shows that the general view that adnexal tumors develop from local adnexal structures is wrong. CONCLUSION Scalp lesions in which the diagnosis is unclear should be biopsied or excised early. Based on the result of the histological examination further therapy can be determined.
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Hofmann-Wellenhof R. Special criteria for special locations 2: scalp, mucosal, and milk line. Dermatol Clin 2013; 31:625-36, ix. [PMID: 24075550 DOI: 10.1016/j.det.2013.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The anatomic region influences the dermoscopic features of different lesions. In this article, the particular characteristics of the scalp, mucosal membranes, and lesions located on the milk line are explained. In histopathology, the benign melanocytic lesions in these locations are also named nevi of special sites, considering the difficulty of the histopathologic diagnosis.
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Affiliation(s)
- Rainer Hofmann-Wellenhof
- Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, Graz A-8038, Austria.
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45
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Wollina U, Bayyoud Y, Krönert C, Nowak A. Giant epithelial malignancies (Basal cell carcinoma, squamous cell carcinoma): a series of 20 tumors from a single center. J Cutan Aesthet Surg 2012; 5:12-9. [PMID: 22557850 PMCID: PMC3339122 DOI: 10.4103/0974-2077.94328] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background: Among nonmelanoma skin cancer (NMSC), basal cell carcinoma (BCC), and squamous cell carcinoma (SCC) are the most common. Giant NMSCs have occasionally reported in the medical literature with particular problems related to diagnosis and treatment. The aim of this study was to analyze patients, treatment, and outcome with giant BCC/SCC. Materials and Methods: We analyzed our files between January 1, 2008, and December 31, 2011, of an academic teaching hospital in the dermatology department. Patients were analyzed according to demographic factors, clinical presentation, histopathology, treatment, and outcome. American Society of Anesthesiology physical status system was used to assess the fitness of patients before surgery. Results: The frequency of giant NMSC was estimated as 0.4% for both tumor entities. 80% of giant BCC patients were female and 100% of giant SCC patients were male. The mean age was 81.5 ± 8.5 years for BCC) and 79.5 ± 11.4 years for SCC. The major anatomical site was the scalp. Four of 10 BCCs were classified metatypic (basosquamous). Perineural infiltration was seen in 5 NMSCs. Seventy percent of patients had an ASA score ≥3. Surgery was performed in general anaesthesia in 5 (BCC) and 6 (SCC) patients, respectively. All other patients were operated in local or tumescence anesthesia. Blood transfusions were necessary in five patients. The primary treatment was delayed Mohs technique. Defect closure was realized with rotational flaps in most cases. Neoadjuvant chemoimmune therapy and adjuvant combined cetuximab/radiotherapy have been performed in three patients. We observed three deaths, all unrelated to NMSC. 75% of patients achieved complete remission. Conclusions: Giant NMSC is uncommon but not rare. These tumors are high-risk subtypes. Treatment needs an interdisciplinary approach.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
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Marcoval J, Penín RM, Llatjós R, Martínez-Ballarín I. Cutaneous metastasis from lung cancer: Retrospective analysis of 30 patients. Australas J Dermatol 2011; 53:288-90. [PMID: 23157780 DOI: 10.1111/j.1440-0960.2011.00828.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Joaquim Marcoval
- Departments of Dermatology Pathology Pneumology, Bellvitge Hospital, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain.
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Wang WL, Bones-Valentin RA, Prieto VG, Pollock RE, Lev DC, Lazar AJ. Sarcoma metastases to the skin: a clinicopathologic study of 65 patients. Cancer 2011; 118:2900-4. [PMID: 21989966 DOI: 10.1002/cncr.26590] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 08/18/2011] [Accepted: 08/19/2011] [Indexed: 01/22/2023]
Abstract
BACKGROUND Sarcoma metastases to the skin are relatively rare, because most involve the lung, liver, or deep soft tissues. The authors of this report examined the distribution and clinical significance of cutaneous and superficial subcutaneous sarcoma metastases. METHODS Sixty-five patients with histologically confirmed dermal and superficial subcutaneous sarcoma metastases were identified in pathology files from more than 25,000 patients with sarcoma who were evaluated at The University of Texas M. D. Anderson Cancer Center from 1989 to 2009. Pathology slides and clinical and radiological information were evaluated. RESULTS Cutaneous metastases were documented histologically in <0.25% of patients. The mean patient age was 49 years (range, 16-79 years), and there was an equivalent ratio of men to women. The most common source of metastasis was leiomyosarcoma (28 of 65 patients; 43%). The most common region of first skin metastasis was head and neck (33 patients; 51%), and the scalp predominated (25 patients; 38%). The mean time from primary tumor diagnosis to skin metastasis was 48 months (range, 0-166 months). Fifty-three patients (81%) had multiple metastases (skin and other). Among the patients who had complete clinical information available, 31 patients (62%) had other metastases diagnosed before skin involvement, 17 patients (34%) had skin metastases diagnosed first, and 2 patients (4%) had simultaneous presentation. The following clinical outcomes were documented: Twenty-nine patients (45%) died of disease, 24 patients (37%) remained alive with disease, and 12 patients were lost to follow-up. The mean time to death was 80 months (range, 9-224 months) after primary diagnosis, 45 months (range, 5-94 months) after the first metastasis to any site, and 27 months (range, 5-65 months) after the first skin metastasis. CONCLUSIONS Sarcoma metastases to the skin are rare. In this large study, leiomyosarcoma was the most common source, and the scalp was the most frequent site. The majority of patient with skin metastases harbored metastases elsewhere. However, skin was the initial site of metastasis in approximately 1 in 3 patients. Thus, clinical correlation is needed before establishing a diagnosis of primary cutaneous sarcoma, particularly leiomyosarcoma of scalp. Finally, the current results indicated that skin metastasis usually is a late event in sarcoma clinical progression and heralds a poor prognosis.
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Affiliation(s)
- Wei-Lien Wang
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Stanganelli I, Argenziano G, Sera F, Blum A, Ozdemir F, Karaarslan IK, Piccolo D, Peris K, Kirchesch H, Bono R, Pizzichetta MA, Gasparini S, Braun RP, Correia O, Thomas L, Zaballos P, Puig S, Malvehy J, Scalvenzi M, Rabinovitz H, Bergamo A, Pellacani G, Longo C, Pavlovic M, Rosendahl C, Hofmann-Wellenhof R, Cabo H, Marghoob AA, Langford D, Astorino S, Manganoni AM, Gourhant JY, Keir J, Grichnik JM, Fumo G, Dong H, Sortino Rachou AM, Ferrara G, Zalaudek I. Dermoscopy of scalp tumours: a multi-centre study conducted by the international dermoscopy society. J Eur Acad Dermatol Venereol 2011; 26:953-63. [PMID: 21790795 DOI: 10.1111/j.1468-3083.2011.04188.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about the dermoscopic features of scalp tumours. Objective To determine the dermoscopic features of scalp tumours. METHODS Retrospective analysis of dermoscopic images of histopathologically diagnosed scalp tumours from International Dermoscopy Society members. RESULTS A total of 323 tumours of the scalp from 315 patients (mean age: 52 years; range 3-88 years) were analysed. Scalp nevi were significantly associated with young age (<30 years) and exhibited a globular or network pattern with central or perifollicular hypopigmentation. Melanoma and non-melanoma skin cancer were associated with male gender, androgenetic alopecia, age >65 years and sun damage. Atypical network and regression were predictive for thin (≤1 mm) melanomas, whereas advanced melanomas (tumour thickness > 1 mm) revealed blue white veil, unspecific patterns and irregular black blotches or dots. CONCLUSIONS The data collected provide a new knowledge regarding the clinical and dermoscopy features of pigmented scalp tumours.
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Affiliation(s)
- I Stanganelli
- Skin Cancer Unit, Istituto Tumori Romagna (IRST), Meldola (FC), Italy
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Richmond HM, Duvic M, Macfarlane DF. Primary and metastatic malignant tumors of the scalp: an update. Am J Clin Dermatol 2010; 11:233-46. [PMID: 20509718 DOI: 10.2165/11533260-000000000-00000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In recent years there have been a number of interesting advances in several topics relating to the diagnosis and treatment of cutaneous lesions with particular applicability to primary and metastatic malignancies of the scalp. In this article we provide a general update of advances in this field, and cover the more salient points relating to a variety of malignant tumors that have been reported to appear on the scalp as primary or metastatic lesions. A search and review of the literature on PubMed was made to identify and discuss relevant points relating to diagnosis and treatment of primary and metastatic tumors of the scalp. We describe the anatomy of the scalp, epidemiology of scalp tumors, theories of field cancerization and field therapy, photodynamic therapy, excisional surgical techniques and reconstruction, lymphoscintigraphy, chemoprevention, as well as details relating to atypical fibroxanthoma, Brooke-Spiegler syndrome, nevus sebaceus, cutaneous lymphoma, and metastatic disease. There is a very broad differential diagnosis for scalp nodules, which includes many different benign and malignant diseases, and treatment should be tailored accordingly. Given the potential for poor prognosis with some of the more aggressive malignancies that can be found in this anatomic area, the importance of a thorough physical examination cannot be emphasized enough, and early detection is critical to provide patients with the best chance for a favorable outcome.
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Affiliation(s)
- Heather M Richmond
- Department of Dermatology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
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