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Cedirian S, Rapparini L, Sechi A, Piraccini BM, Starace M. Diagnosis and Management of Scalp Metastases: A Review. Diagnostics (Basel) 2024; 14:1638. [PMID: 39125514 PMCID: PMC11311314 DOI: 10.3390/diagnostics14151638] [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: 07/01/2024] [Revised: 07/26/2024] [Accepted: 07/28/2024] [Indexed: 08/12/2024] Open
Abstract
Scalp metastases (SMs) are particularly noteworthy, representing around 4-7% of cutaneous neoplasms in this region of the body, possibly due to its rich blood supply. Diagnosis of SMs involves a systematic approach encompassing oncologic history, clinical examination, dermoscopy, imaging, and histopathological assessment. Clinical presentations of SM can vary, but dermoscopy reveals unique vascular patterns aiding in diagnosis. Imaging, particularly MRI and CT, and histopathological evaluation are mandatory for definitive diagnosis. Treatment strategies vary depending on tumor characteristics and staging, ranging from surgical excision to systemic therapies like chemotherapy or radiotherapy. Multimodal approaches tailored to individual cases yield optimal outcomes. The diagnostic tools available do not always allow SMs to be diagnosed, and often the lack of knowledge on the part of oncologists in suspecting SMs can delay an early diagnosis. This review provides clinicians with a practical guide for the timely diagnosis and management of SM, emphasizing the importance of a multidisciplinary approach and personalized treatment strategies for improved patient outcomes.
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Affiliation(s)
- Stephano Cedirian
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (S.C.); (B.M.P.); (M.S.)
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Luca Rapparini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (S.C.); (B.M.P.); (M.S.)
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Andrea Sechi
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Bianca Maria Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (S.C.); (B.M.P.); (M.S.)
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Michela Starace
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (S.C.); (B.M.P.); (M.S.)
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
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2
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Lee HW, Hwang YJ, Jung SG, Hong IP. Nodular scalp mass as the first presentation of pulmonary large cell neuroendocrine carcinoma: a case report. Arch Craniofac Surg 2023; 24:240-243. [PMID: 37919912 PMCID: PMC10622950 DOI: 10.7181/acfs.2023.00304] [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: 06/12/2023] [Revised: 06/28/2023] [Accepted: 10/09/2023] [Indexed: 11/04/2023] Open
Abstract
Metastasis of lung cancer to the skin is uncommon, presenting in 0.22% to 12% of lung cancer patients, and it is extremely rare for skin metastasis to be the first clinical manifestation of lung cancer. In the few cases where skin metastasis has been reported as the first sign of lung cancer, the patients were typically heavy smokers or had preexisting respiratory diseases and symptoms. This prompted clinicians to consider skin metastasis of a pulmonary malignancy. Large cell neuroendocrine carcinoma (LCNEC) is a rare type of lung cancer that accounts for approximately 3% of lung cancers. LCNEC mainly metastasizes to visceral organs, such as the liver, bone, and brain, and it only shows metastasis to the skin in very rare cases. Herein, we report an unusual case of a metastatic skin lesion as the first sign of primary pulmonary LCNEC, in a 63-year-old woman with no pulmonary symptoms or personal history of smoking or pulmonary disease.
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Affiliation(s)
- Hong Won Lee
- Department of Plastic and Reconstructive Surgery, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Young Joong Hwang
- Department of Plastic and Reconstructive Surgery, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Sung Gyun Jung
- Department of Plastic and Reconstructive Surgery, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea
| | - In Pyo Hong
- Department of Plastic and Reconstructive Surgery, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea
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3
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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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4
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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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5
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Falbo F, Krizzuk D, Urciuoli P, Biancucci A, Galiffa G, Donello C, Esposito A, Mongardini FM, Sammartino F. Lung Tumor Skin Metastasis: Case Report of a Solitary Cutaneous Ulcerated Lesion as Initial Manifestation of Lung Carcinoma. Case Rep Oncol 2022; 15:1034-1038. [PMID: 36605228 PMCID: PMC9808127 DOI: 10.1159/000527077] [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: 07/28/2022] [Accepted: 09/07/2022] [Indexed: 11/12/2022] Open
Abstract
Lung cancer has the highest cancer incidence, and it is the most common cause of cancer death worldwide. Cutaneous metastases are infrequent compared to hilar nodes, adrenal glands, liver, brain, and bones. However, unusual skin lesions in patients at high risk of lung cancer should be regarded carefully to rule out a metastatic manifestation of an occult primary site tumor. Surgical excision, or incisional biopsy when the former is deemed unfeasible, should be performed to allow histopathological examination in case of occult primary site. In patients affected by advanced lung tumors, surgical excision could be beneficial in terms of pain control and improvement of the quality of life. We report a case of a solitary large skin lesion as an early manifestation of a lung adenocarcinoma.
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Affiliation(s)
- Francesco Falbo
- UO Chirurgia Generale, Casa di Cura Aurelia Hospital, Rome, Italy
| | - Dimitri Krizzuk
- UO Chirurgia Generale, Casa di Cura Aurelia Hospital, Rome, Italy
| | - Paolo Urciuoli
- Dipartimento di Scienze Chirurgiche, AOU Policlinico “Umberto I”, Rome, Italy
| | - Andrea Biancucci
- UO Chirurgia Generale, Casa di Cura Aurelia Hospital, Rome, Italy
| | | | - Claudia Donello
- UOS Pronto Soccorso e Medicina d’Urgenza, Ospedale Dei Castelli, Ariccia, Italy
| | - Anna Esposito
- Dipartimento di Scienze Chirurgiche, AOU Policlinico “Umberto I”, Rome, Italy
| | - Federico Maria Mongardini
- UOC Chirurgia Generale, mininvasiva, Oncologica e Dell’obesità, AOU “Luigi Vanvitelli”, Campania, Italy
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6
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Kost Y, Mattis DM, Muskat A, Nazarian R, Amin B, Cheng H, McLellan BN. Cutaneous metastasis as the first sign of small-cell cancer: An unexpected presentation in a patient with concurrent prostate cancer. JAAD Case Rep 2022; 26:104-106. [PMID: 35958435 PMCID: PMC9357704 DOI: 10.1016/j.jdcr.2022.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Beth N. McLellan
- Correspondence to: Beth N. McLellan, MD, Department of Medicine, Division of Dermatology, Montefiore Medical Center, Albert Einstein College of Medicine, 3411 Wayne Avenue, Bronx, NY 10467.
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7
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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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8
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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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9
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Manivannan S, Sharouf F, Lammie G, Leach P. Unusual cause of a painless soft tissue mass of the scalp: a rare presentation of primary intracranial neuroendocrine neoplasm. BMJ Case Rep 2021; 14:14/2/e236856. [PMID: 33619129 PMCID: PMC7903122 DOI: 10.1136/bcr-2020-236856] [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: 11/04/2022] Open
Abstract
Incidental soft tissue lumps in the scalp are a common presenting complaint in clinical practice. However, they may signify more sinister underlying pathologies. Our report examines a 63-year-old man presenting with impaired co-ordination in his left hand following a 3-month history of a painless left retroauricular scalp lump. MRI revealed a large left occipital soft tissue mass eroding through the underlying skull with infiltration into the underlying cerebellum and temporal lobe. Open biopsy confirmed a diagnosis of high-grade intracranial neuroendocrine tumour (NET). At approximately 5 months following successful tumour resection and adjuvant chemotherapy, he developed tumour recurrence and was subsequently palliated, and died at 1 year post diagnosis. Herein, we review other cases of primary intracranial NET, clinical findings, histopathological features and prognosis.
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Affiliation(s)
- Susruta Manivannan
- Neurosurgery, Southampton University Hospitals NHS Trust, Southampton, UK
| | - Feras Sharouf
- School of Medicine, Cardiff University, Cardiff, UK .,Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | | | - Paul Leach
- Department of Neurosurgery, University Hospital of Wales, Cardiff University, Cardiff, UK
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10
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Shavit E, Alkallabi M, Alavi A. Scalp ulcers - differential diagnoses that should be sought! Int J Dermatol 2019; 58:1283-1292. [PMID: 31267525 DOI: 10.1111/ijd.14539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/29/2019] [Accepted: 05/20/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ulceration of the scalp is an uncommon clinical presentation, and it may be caused by myriads of cutaneous etiologies such as infections, inflammatory disorders, and malignancies. We sought to reveal the underlying etiology of scalp ulcers referred to our tertiary wound healing clinic; we would also like to propose a classification for scalp ulcerations. METHODS A retrospective study was conducted in an academic tertiary wound healing clinic between January 2015 and June 2018. The study was approved by the Women's College Hospital Institutional Research Ethics Board. We have also conducted a review of the literature to recognize the major causes of scalp ulceration reported in the literature. RESULTS We have identified a total number of 15 patients with scalp ulceration. Twelve patients with atypical scalp ulcers underwent a skin biopsy. A malignancy rate of 73% (11/15) was diagnosed histologically. The review of the literature showed 237 articles. After screening the title and the abstracts, we have selected 41 case reports for the full text review. CONCLUSION Scalp ulcers are uncommon but important. Our sample study indicates the high frequency of malignant etiologies presenting as scalp ulcers. These results emphasize not only the need for clinicians to be on the watch for the possibility of this option but rather highlights the need for early biopsy to prevent further complications. We hope that our paper helps to shed some light on this topic and guide clinicians on how to approach scalp ulceration.
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Affiliation(s)
- Eran Shavit
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Mona Alkallabi
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Afsaneh Alavi
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
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11
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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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12
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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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13
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Liao Y, Zhou L, Li M, Yu S, Zhou Y, Xie L. Cutaneous metastasis from lung adenocarcinoma presenting before discovery of the primary malignancy: a case report. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2019; 12:657-663. [PMID: 31933871 PMCID: PMC6945094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 01/26/2019] [Indexed: 06/10/2023]
Abstract
Cutaneous metastasis from lung adenocarcinoma is rarer than liver, adrenal, brain, bone and other distant metastases, and the prognosis is very poor. We report a case of a 42-year-old Asian male lung adenocarcinoma patient with lymph node metastases and cutaneous metastases to the right chest wall that appeared during the comprehensive treatments, without any lesion previously found in the lung. The patient was positive for the EGFR18 exon and had an excellent tumor response to the EGFR tyrosine kinase inhibitor (EGFR-TKI) with a duration of efficacy of up to 22 months. Then, the area of right chest wall lesions expanded with ulceration, and gene detection from peripheral blood indicated that the patient acquired resistance to the administered EGFR-TKI therapy. A bilateral pleural effusion occurred 1 month later upon changing treatment to the third generation of EGFR-TKI. Then, the pleural effusion was controlled, but a change in the chest wall skin lesions was not obvious until after treatment with bevacizumab combined with cisplatin pleural perfusion. Currently, the patient is administered S-1 for maintaining treatment. Current follow-up time is more than 48 months, and the KPS score is 80 points. Through this case and a review of relevant literature, we discuss the clinical manifestations, diagnosis, treatment and prognosis of this disease and intend to provide a reference for the clinical diagnosis and treatment of similar diseases.
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Affiliation(s)
- Yedan Liao
- Department of Medical Oncology, The Third Affiliated Hospital of Kunming Medical University (Tumor Hospital of Yunnan Province)Kunming, Yunnan, China
| | - Ling Zhou
- Department of Medical Oncology, The Third Affiliated Hospital of Kunming Medical University (Tumor Hospital of Yunnan Province)Kunming, Yunnan, China
| | - Mei Li
- Department of Clinical Pathology, The Third Affiliated Hospital of Kunming Medical University (Tumor Hospital of Yunnan Province)Kunming, Yunnan, China
| | - Shunling Yu
- Department of Medical Oncology, The Third Affiliated Hospital of Kunming Medical University (Tumor Hospital of Yunnan Province)Kunming, Yunnan, China
| | - Yonghong Zhou
- Department of Medical Oncology, The Third Affiliated Hospital of Kunming Medical University (Tumor Hospital of Yunnan Province)Kunming, Yunnan, China
| | - Lin Xie
- Department of Medical Oncology, The Third Affiliated Hospital of Kunming Medical University (Tumor Hospital of Yunnan Province)Kunming, Yunnan, China
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14
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Yu Q, Subedi S, Tong Y, Wei Q, Xu H, Wang Y, Gong Y, Shi Y. Scalp metastases as first presentation of pulmonary adenocarcinomas: a case report. Onco Targets Ther 2018; 11:6147-6151. [PMID: 30288050 PMCID: PMC6160265 DOI: 10.2147/ott.s174577] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cutaneous metastasis from primary visceral malignancy is a relatively uncommon clinical entity, with a reported incidence ranging from 0.22% to 12% of all malignancies. Here we report a 64-year-old asymptomatic female patient with Peutz–Jeghers syndrome presenting with multiple scalp metastases as the initial manifestation secondary to lung adenocarcinoma. Subsequent lung computed tomography scan showed large masses involving the left upper lobe associated with extensive mediastinal lymphadenopathy. After treatment with an epidermal growth factor receptor inhibitor gefitinib, the size of the tumor in the lung reduced significantly and the condition of the patient also gradually improved. Our case demonstrated that scalp metastasis could be the first sign of an internal malignancy. Asymptomatic elderly patients presenting with multiple, painless, immobile cutaneous nodules should be considered for further investigations to rule out the underlying primary cause. Metastasis to the skin is often a preterminal event that heralds poor prognosis.
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Affiliation(s)
- Qian Yu
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, People's Republic of China, .,Institute of Psoriasis, Tongji University School of Medicine, Shanghai 200072, People's Republic of China,
| | - Smriti Subedi
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, People's Republic of China, .,Institute of Psoriasis, Tongji University School of Medicine, Shanghai 200072, People's Republic of China,
| | - Yunlei Tong
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, People's Republic of China, .,Institute of Psoriasis, Tongji University School of Medicine, Shanghai 200072, People's Republic of China,
| | - Qing Wei
- Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, People's Republic of China
| | - Hui Xu
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, People's Republic of China, .,Institute of Psoriasis, Tongji University School of Medicine, Shanghai 200072, People's Republic of China,
| | - Yao Wang
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, People's Republic of China, .,Institute of Psoriasis, Tongji University School of Medicine, Shanghai 200072, People's Republic of China,
| | - Yu Gong
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, People's Republic of China, .,Institute of Psoriasis, Tongji University School of Medicine, Shanghai 200072, People's Republic of China,
| | - Yuling Shi
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, People's Republic of China, .,Institute of Psoriasis, Tongji University School of Medicine, Shanghai 200072, People's Republic of China,
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Qiu JQ, Cui Y, Sun LC, Zhu ZP. Subcutaneous metastasis after three surgeries for brain metastasis from lung cancer: A case report and review of the literature. Mol Clin Oncol 2016; 5:697-700. [PMID: 28105349 PMCID: PMC5228495 DOI: 10.3892/mco.2016.1039] [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: 07/25/2016] [Accepted: 09/23/2016] [Indexed: 11/10/2022] Open
Abstract
Lung cancer is a common malignancy that is frequently associated with distant subcutaneous metastasis. However, reports of subcutaneous metastasis of lung cancer after three surgeries for recurrent brain metastasis are scarce. The present study describes the case of a 49-year-old female patient who was admitted to our hospital with a cutaneous mass. The patient had a history of lung cancer and had undergone three surgeries for brain metastases. The subcutaneous mass was considered to be an implantation metastasis from the previous brain metastases. The cutaneous mass was grossly resected and histopathological examination revealed adenocarcinoma. This case highlights the need to perform a comprehensive analysis for suspected subcutaneous masses in lung cancer patients. Furthermore, pathological examination is crucial for accurate diagnosis and timely treatment.
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Affiliation(s)
- Ji-Qing Qiu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yu Cui
- Department of Otolaryngology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Li-Chao Sun
- Department of Emergency, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zhan-Peng Zhu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
- Correspondence to: Dr Zhan-Peng Zhu, Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, Jilin 130021, P.R. China, E-mail:
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Hussain J, Westerveld D, Sattari M. Cutaneous metastasis: a rare herald of a silent cancer. BMJ Case Rep 2016; 2016:bcr-2015-213734. [PMID: 26783009 DOI: 10.1136/bcr-2015-213734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 59-year-old previously healthy man with a 50-pack-year smoking history presented with rib pain 1 month after a mechanical fall. Physical examination revealed a 1.5 cm right cervical lymph node and a 0.9 × 0.9 cm scalp nodule. The patient had only noticed the scalp lesion a month prior to presentation. Chest X-ray revealed a 5.8 × 5.0 cm left infrahilar mass. CT angiography demonstrated extensive metastatic mediastinal and right hilar adenopathy as well as hepatic, right adrenal and brain lesions. Pathology from fine-needle aspiration of cervical lymph nodes and punch biopsy of the scalp lesion were consistent with non-small cell lung cancer (NSCLC) metastasis. The patient underwent brain stereotactic radiosurgery and palliative radiation therapy. Unfortunately, he passed away 4 months after diagnosis. Malignancy (primary or secondary) should be considered by clinicians in the work up of patients with new skin lesions, particularly in those at high risk of cancer.
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Affiliation(s)
- Jonathan Hussain
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Donevan Westerveld
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Maryam Sattari
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
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