Giant Scalp Research Articles

Giant Scalp Metastasis: an Unusual Presentation of Cutaneous Malignant Melanoma

Cutaneous metastases from primary malignant melanoma of the skin are fairly common. However, distant cutaneous metastasis to the scalp is unusual. We present a case of giant scalp metastasis secondary to primary cutaneous nodular malignant melanoma of the heel in the setting of disseminated disease. Majority of melanomas occurring over the feet are acral lentiginous type, nodular melanomas being extremely uncommon. An association of a rare site of primary nodular melanoma with a rare site of metastases makes this case extremely unusual and, hence, worth reporting. Besides the atypical and rare manifestation of a common disease, the main aim of presenting this report is to highlight that scalp metastasis may rarely be the initial presentation of an occult cutaneous melanoma, and in such cases, a thorough head-to-toe cutaneous examination is essential to identify the primary lesion. Although prognosis of metastatic cutaneous melanoma is poor, awareness about the aggressive course of such lesions will assist clinicians in prompt diagnosis and early initiation of palliative treatment options.

Primary central nervous system lymphoma presenting as giant scalp tumor: a case report with review of literature

Primary central nervous system lymphoma presenting as giant scalp tumor: a case report with review of literature

Giant Subgaleal cerebrospinal fluid leakage: An unusual complication of chronic subdural hematoma surgery

Abstract We report a rare case of chronic subdural hematoma complicated with a Giant subgaleal cerebrospinal fluid leakage. Physical examination was performed with no alteration in mental status and no focal neurological disorder. The subdural hematoma was drained and two weeks later, patient was admitted to our hospital with a giant scalp swelling. Physical examination revealed a left parietal subcutaneous collection. The patient was reoperated with a correction in the fistula, he presented a satisfactory postoperative evolution. To our knowledge, this is the first report in literature of a chronic subdural hematoma with a complicated giant subgaleal cerebrospinal fluid leakage.

Giant Malignant Peripheral Nerve Sheath Tumor of Scalp in Non-neurofibromatosis Person: A Rare Case Report

AbstractMalignant peripheral nerve sheath tumors (MPNSTs) are rare neoplasms, usually arising from components of nerve sheath such as perineural fibroblasts or Schwann cells. Primary scalp MPNST is an exceptionally rare entity and only few cases have been reported till date. We encountered an unusual case of giant scalp MPNST in a 70-year-old man without any history suggestive of neurofibromatosis associated with intracranial extension with underlying bone destruction. The tumor was treated with complete surgical excision followed by adjuvant radiotherapy. Histopathological examination showed hyper- and hypocellular areas of spindle cells admixed with myxoid areas and immunohistochemistry revealed positivity to vimentin and S100 on the basis of which the diagnosis of MPNST was made.

Neurophysiological and BOLD signal uncoupling of giant somatosensory evoked potentials in progressive myoclonic epilepsy: a case-series study

In progressive myoclonic epilepsy (PME), a rare epileptic syndrome caused by a variety of genetic disorders, the combination of peripheral stimulation and functional magnetic resonance imaging (fMRI) can shed light on the mechanisms underlying cortical dysfunction. The aim of the study is to investigate sensorimotor network modifications in PME by assessing the relationship between neurophysiological findings and blood oxygen level dependent (BOLD) activation. Somatosensory-evoked potential (SSEP) obtained briefly before fMRI and BOLD activation during median-nerve electrical stimulation were recorded in four subjects with typical PME phenotype and compared with normative data. Giant scalp SSEPs with enlarger N20-P25 complex compared to normal data (mean amplitude of 26.2 ± 8.2 μV after right stimulation and 27.9 ± 3.7 μV after left stimulation) were detected. Statistical group analysis showed a reduced BOLD activation in response to median nerve stimulation in PMEs compared to controls over the sensorimotor (SM) areas and an increased response over subcortical regions (p < 0.01, Z > 2.3, corrected). PMEs show dissociation between neurophysiological and BOLD findings of SSEPs (giant SSEP with reduced BOLD activation over SM). A direct pathway connecting a highly restricted area of the somatosensory cortex with the thalamus can be hypothesized to support the higher excitability of these areas.

Trapezius Flap Reconstruction of Scalp Defect After Removal of Occipital Fibrosarcoma in Neurofibromatosis Type I Patient

Neurofibromatosis type 1 (NF1) is an autosomal dominant condition affecting approximately 1 in 3000 live births. The manifestations of this condition are extremely variable, even within families, and genetic counseling is consequently difficult with regard to prognosis. Individuals with NF1 are acknowledged to be at increased risk of malignancy. Several studies have previously attempted to quantify this risk, but have involved relatively small study populations. Soft tissue tumors represent a heterogeneous group of mesenchymal and neural lesions. We report a case of giant scalp Fibrosarcoma of the scalp in patient with neurofibromatosis type I without intracranial extension, in a 35 year old female which was excised completely along with the involved overlying skin, and reconstruction was done to cover the defect using trapezius flap and split thickness skin graft from the right thigh. She is doing well after treatment and is in regular follow up while awaiting further management by the oncologists.

GIANT SCALP MELANOMA

To the Editor, A 54-year-old female presented with a 4-month history of extensive dark-colored lesions on her scalp. The pathology result of a previous biopsy from her scalp performed by a general surgeon a year ago had been congenital melanocytic nevus. Dermatological examination showed confluent blue-grey, dark brown macules, papules and nodules covering most of the left parietofrontotemporal scalp in an area measuring 15x30 cm in size (Figure 1a). There were also satellite lesions of varying diameters on the ear, anterior trunk and one pigmented lesion of the oral mucosa. Dermoscopic analysis of the lesions revealed asymmetry of color and structure, multicomponent global pattern, irregular dots and globules and bluish-white color (Figure 1b). Histopathologic examination of three 4-mm punch biopsies from the patient’s scalp revealed atypical melanocytic lesions with findings that were not adequate to confirm melanoma. Total excision of the scalp lesion was not approved by plastic surgery. The total excision material of the pigmented lesion on her anterior trunk was referred to another pathologist and revealed superficial spreading melanoma with Breslow thickness of 1 mm, Clark level of 3 and mitotic rate of 2/mm² (Figure 1c). In addition, pulmonary metastases were detected by total body positron emission tomography-computed tomography (PET-CT). The case was accepted as T1N3M1 inoperable metastatic malign melanoma originating from the scalp lesion. Vemurafenib treatment was started by medical oncology. However, the patient developed nodules and ulcerations, cervical lymph node metastasis and vena cava superior syndrome during the treatment and died nine months after the diagnosis. Giant melanoma is a rare presentation of cutaneous melanomas. A literature search revealed 18 previous patients with giant melanoma with only three originating from the scalp (1-4). Most giant melanoma cases have no precursor lesion but the lesion developed in a congenital nevus in two cases and from a previous melanocytic nevus in another two cases (5). No precursor lesion was found in three cases with giant scalp melanoma (1, 3, 4). On the other hand, our patient described a pigmented lesion on her scalp since childhood and a biopsy from the lesion had revealed a congenital melanocytic nevus. Giant melanomas usually present as a vegetative tumor with high Breslow thickness. Two of the three patients with a giant scalp melanoma in the literature presented with a vegetative tumor, and the other one presented with confluent purple-blue-gray macules, papules and nodules as in our patient (1, 3, 4). Excisional biopsy from the anterior trunk in our case revealed superficial spreading melanoma with a Breslow thickness of 1 mm while three punch biopsies from the scalp were not sufficient to confirm melanoma. The punch biopsy method might not be helpful in the diagnosis of some giant melanomas, probably due to sampling errors. Dermoscopy is also generally inadequate in identifying the suspicious areas in these cases. We therefore recommend a large incisional biopsy or excisional biopsy instead of punch biopsy in giant melanomas to avoid delays in diagnosis

Surgical Management of Giant Scalp Neurofibroma After Ultra-Selective Embolization of Nutrient Artery.

Neurofibroma, a common benign tumor in soft tissue, continues to grow, so it often appears to be giant. Surgical management of giant neurofibroma is a challenge due to the risk of excessive bleeding. Embolization of tumor's nutrient artery may reduce the blood loss in operation. This study introduces the surgical management of giant scalp neurofibroma with preoperative ultra-selective embolization of nutrient artery. From January 2006 to December 2013, 9 patients with giant scalp neurofibroma were enrolled into the study. Digital subtraction angiography (DSA) showed tumor's nutrient artery. Ultra-catheter was inserted into the nutrient artery and its branches as close as possible to the tumor. Then ultra-selective embolization was performed with gelatin sponge particles. Surgical removal of tumor was performed in 3 days after embolization. The wound was repaired by skin graft. All of the 9 patients underwent successful DSA and ultra-selective embolization. Among them, occipital artery was embolized in 3 patients (left side in 1 patient and right side in 2 patients). Both occipital artery and superficial temporal artery were embolized in 6 patients (left side in 2 patients, right side in 3 patients, and both side in 1 patient). No complications, such as ectopic embolism, occurred in the patients. All of the tumors were resected completely without blood transfusion. The skin graft survived very well on the wounds. Preoperative ultra-selective embolization of nutrient artery is a feasible, safe, and effective method to reduce the blood loss in operation and facilitate the surgical management of giant scalp neurofibroma.

Unusual cutaneous metastatic follicular thyroid carcinoma

Follicular thyroid carcinoma (FTC) is the second most common thyroid cancer (TCs) after papillary carcinoma, but it is ranked first in producing distant metastases among TCs. It accounts for 10 – 20% of all thyroid malignancies and is most often seen in patients over 40 years of age. Distant metastases at the time of diagnosis are reported in 11 – 20% of the patients and may be the reason for presentation. There have been less than 30 reported cases of cutaneous metastases from FTC in the English Literature, a majority affecting the scalp. We present an unusual aggressive, hypervascular FTC in a 58-year-old man with a previous diagnosis of multinodular goiter. The difficulty in gaining his acceptability of orthodox management resulted in the development of multiple giant scalp and right facial metastatic masses associated with lytic calvarial destruction and the involvement of frontal and right maxillary sinuses. These imposed serious challenges in managing him in a resource-poor community.

Multiple giant scalp metastases of a follicular thyroid carcinoma

BackgroundThe occurrence of skin metastases are rare events in the course of a follicular thyroid carcinoma (FTC) and usually indicate advanced tumor stages. The scalp is the most affected area of these metastases.Case presentationWe present a case of a 76 year old Woman with multiple giant scalp metastases of a follicular carcinoma. These metastases had been resected and wounds had been closed with mesh graft. The 14-months follow up is presented.ConclusionWe demonstrate another case with multicentric form. Because of its location and size a primary wound closure was not possible. A healing could be reached using vacuum therapy and mesh graft transplantation.

Nd:YAG laser for effective treatment of multiple cylindroma of the scalp

The case presented illustrates the successful effect of the Nd:YAG laser in the treatment of multiple giant scalp tumours in a patient who would not accept surgical excisions. A 60‐year‐old woman with multiple cylindroma covering the whole scalp area was treated with a Nd:YAG laser in a cutting continuous mode. Postoperative healing by second intention within 3–4 weeks left limited superficial scars. No tendency to relapse was noted during a follow‐up of 4 years.