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Tomasini CF, Fiandrino G, Favale EM, Antoci F, Barruscotti S. Giant Morpheaform Basal Cell Carcinoma Mimicking Scarring Alopecia: Exception Prone to Neglect. Dermatopathology (Basel) 2024; 11:154-160. [PMID: 38921053 PMCID: PMC11202933 DOI: 10.3390/dermatopathology11020016] [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: 02/29/2024] [Revised: 05/21/2024] [Accepted: 06/03/2024] [Indexed: 06/27/2024] Open
Abstract
A 74-year-old woman in good general health presented with a 5-year history of progressive hair loss over several years, interpreted as female androgenetic alopecia (AGA), and was treated with topical 5% Minoxidil without improvement. The patient's relevant medical history revealed infiltrating, triple-negative apocrine carcinoma of the right breast four years before, treated by quadrantectomy, radiation, lymphadenectomy and chemotherapy, with no recurrence at the last follow-up. On examination, there was an asymptomatic 15 × 15 cm firm and whitish area of scarring alopecia on the central scalp. Dermoscopy revealed multiple arborizing vessels and many telangiectasia. The clinical considerations included mainly cutaneous metastasis of breast carcinoma (alopecia neoplastica), pseudopelade of Broque and morpheaform basal cell carcinoma (BCC). A histopathologic examination revealed characteristic changes of morpheaform BCC with basaloid islands and cords of atypical basaloid cells diffusely infiltrating the dermis, embedded in a sclerotic and hypervascularized stroma. Secondary alopecia neoplastica due to morpheaform BCC on the scalp is an exceedingly rare entity, possessing subtle clinical features that may mimic both scarring and non-scarring alopecia. Delayed recognition may contribute to aggressive behavior and extensive local destruction. Treatment with hedgehog inhibitors in locally advanced BCC of the scalp, both in adjuvant and neoadjuvant modalities, is promising.
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Affiliation(s)
- Carlo Francesco Tomasini
- Dermatologic Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (E.M.F.); (S.B.)
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Institute of Dermatology, Università degli Studi di Pavia, 27100 Pavia, Italy
| | - Giacomo Fiandrino
- Pathology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (G.F.); (F.A.)
| | - Emanuele Mario Favale
- Dermatologic Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (E.M.F.); (S.B.)
| | - Francesca Antoci
- Pathology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (G.F.); (F.A.)
| | - Stefania Barruscotti
- Dermatologic Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (E.M.F.); (S.B.)
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Institute of Dermatology, Università degli Studi di Pavia, 27100 Pavia, Italy
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Wigley C, Zargaran D, Nikkhah D, Butler P. Ectopic extramammary Paget's disease of the abdominal wall with abdominoplasty reconstruction. BMJ Case Rep 2022; 15:e243322. [PMID: 35351768 PMCID: PMC8966517 DOI: 10.1136/bcr-2021-243322] [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] [Accepted: 09/09/2021] [Indexed: 11/04/2022] Open
Abstract
Ectopic extramammary Paget's disease describes an exceedingly rare intraepithelial adenocarcinoma arising within non-apocrine tissues. We present a case report of E-EPMD arising on the lower abdomen without underlying secondary malignancy in a 56-year-old female patient. We performed a wide local excision of the lesion with subsequent mini abdominoplasty reconstruction.
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Affiliation(s)
- Catrin Wigley
- Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - David Zargaran
- Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
- Division of Surgical Sciences, UCL, London, UK
| | - Dariush Nikkhah
- Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
- Division of Surgical Sciences, UCL, London, UK
| | - Peter Butler
- Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
- Division of Surgical Sciences, UCL, London, UK
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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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Abstract
The interaction between hair and malignancy is complicated. Various hair abnormalities can manifest in oncology patients as a clinical manifestation, the result of cancer therapy, or due to a paraneoplastic condition. The mechanisms of these changes remain unclear. Alopecia is one of the common clinical presentations occurring in oncology patients that affects their quality of life. The condition can concomitantly develop during the course of malignancy or when patients undergo cancer treatment. It is important for physicians to understand alopecia in association with malignancy as it may be an important associated finding or provide the clues to aid diagnosis. The aim of this review is to summarize the clinical characteristics of alopecia that occur in cancer patients and their relationship with the type of malignancy and its treatment.
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Youssef AA, Reygagne P. Successful treatment of extramammary Paget's disease of the scalp with photodynamic therapy. Int J Dermatol 2015; 55:580-2. [PMID: 26235367 DOI: 10.1111/ijd.13005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 01/13/2015] [Accepted: 02/12/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Abdullah Al Youssef
- Department of Dermatology, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia
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Kuniyuki S, Maekawa N. Ectopic extramammary Paget's disease on the head: case report and literature review. Int J Dermatol 2015; 54:e483-6. [DOI: 10.1111/ijd.13018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 12/30/2014] [Accepted: 02/28/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Shuichi Kuniyuki
- Department of Dermatology; Osaka City General Hospital; Osaka Japan
| | - Naoki Maekawa
- Department of Dermatology; Osaka City General Hospital; Osaka Japan
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Debarbieux S, Dalle S, Depaepe L, Jeanniot PY, Poulalhon N, Thomas L. Extramammary Paget's disease of the scalp: examination by in vivoand ex vivoreflectance confocal microscopy. Skin Res Technol 2014; 20:124-6. [DOI: 10.1111/srt.12087] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- S. Debarbieux
- Department of Dermatology, Centre Hospitalier Lyon Sud; Claude Bernard Lyon 1 University; Pierre Bénite Cedex France
| | - S. Dalle
- Department of Dermatology, Centre Hospitalier Lyon Sud; Claude Bernard Lyon 1 University; Pierre Bénite Cedex France
| | - L. Depaepe
- Department of Pathology, Centre Hospitalier Lyon Sud; Lyon 1 University; Pierre Bénite Cedex France
| | - P. Y. Jeanniot
- Department of Maxillo-facial Surgery; Centre Hospitalier Lyon Sud; Pierre Bénite Cedex France
| | - N. Poulalhon
- Department of Dermatology, Centre Hospitalier Lyon Sud; Claude Bernard Lyon 1 University; Pierre Bénite Cedex France
| | - L. Thomas
- Department of Dermatology, Centre Hospitalier Lyon Sud; Claude Bernard Lyon 1 University; Pierre Bénite Cedex France
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Wagner G, Sachse MM. Extramammary Paget disease - clinical appearance, pathogenesis, management. J Dtsch Dermatol Ges 2011; 9:448-54. [PMID: 21205169 DOI: 10.1111/j.1610-0387.2010.07581.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Extramammary Paget disease is a rare malignant neoplasm. With regard to the pathogenesis, two prognostically different forms can be distinguished. The primary form of extramammary Paget disease is an in situ carcinoma of the apocrine gland ducts. In contrast, the secondary form is characterized by an intraepithelial spread due to an underlying carcinoma of the skin or other organ systems. Extramammary Paget disease occurs in older patients. The predilection sites include the entire anogenital skin and less often the axillary region. We present five different patients with this disease, thereby demonstrating its variation in clinical morphology. The lesion usually presents as an erythematous sharply defined spot. The polygonal borders, caused by the centrifugal growth of the tumor, may provide a diagnostic clue. The treatment of choice for extramammary Paget disease remains Mohs' microscopic surgery. However, radiotherapy or topical applications may be alternative treatment options in selected cases. In patients with the secondary form of extramam-mary Paget disease, treatment of the primary tumor is the main approach.
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Affiliation(s)
- Gunnar Wagner
- Department of Dermatology, Bremerhaven Hospital (Reinkenheide), Bremerhaven, Germany.
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Shi G, Ye DW, Yao X, Zhang S, Dai B, Zhang H, Shen Y, Zhu Y, Zhu Y, Xiao W, Ma C. Extramammary Paget's diseases in men from the Shanghai area: its association with PSA level increase. APMIS 2010; 118:777-81. [PMID: 20854472 PMCID: PMC2955970 DOI: 10.1111/j.1600-0463.2010.02657.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Shi G, Ye D-W, Yao X, Zhang S, Dai B, Zhang H, Shen Y, Zhu Y, Zhu Y, Xiao W, Ma C. Extramammary Paget’s diseases in men from the Shanghai area: its association with PSA level increase. APMIS 2010; 118: 777–81. The aim of this study was to determine the incidence of prostate cancer in patients with extramammary Paget’s disease (EMPD). All cases of EMPD diagnosed between 1992 and 2007 in Shanghai Cancer Hospital were collected and analyzed for the incidence of prostate cancer. The median follow-up was 78 months. In total, 38 cases of invasive and 10 cases of in situ EMPD had been registered. A second malignancy was found in 28.9% (11/38) of patients with invasive EMPD and in 30% (3/10) of patients with in situ EMPD. Patients had an increased risk of developing a second cancer compared with the general population (standardized incidence ratio: 1.7; 95% confidence interval 1.2–2.4). Sixteen patients had serum prostate-specific antigen (PSA) level above 4 ng/mL; five developed prostate cancer, three of them with PSA levels beyond 100 ng/mL. The incidence of prostate cancer is 10.4% in this patient group. Patients with EMPD were more likely to have prostate cancer than the general population. Although the prognosis of EMPD is fairly good, a thorough search for a second tumor is recommended.
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Affiliation(s)
- Guohai Shi
- Department of Urology, Cancer Hospital, Fudan University, Shanghai, China
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Cohen PR. Primary alopecia neoplastica versus secondary alopecia neoplastica: a new classification for neoplasm-associated scalp hair loss. J Cutan Pathol 2009; 36:917-8. [PMID: 19586507 DOI: 10.1111/j.1600-0560.2008.01187.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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