Scalp Metastasis Research Articles

Scalp Lesion as the First Manifestation of Pancreatic Adenocarcinoma, A Very Rare Case.

Pancreatic adenocarcinoma is one of the most aggressive tumors. Its diagnosis is usually made in locally advanced or metastatic disease and survival is less than one year. The most frequent sites of metastatic involvement are the liver, peritoneum and lungs. Other organs such as the bones or the brain may be affected to a lesser extent. Cutaneous involvement of pancreatic adenocarcinoma is extremely rare with less than 150 cases reported in the literature since 1960. Most cases with cutaneous involvement involve the periumbilical region, in a lesion known as "Sister Mary Joseph's Node". Scalp metastases are very rare and their diagnosis suggests advanced disease and the prognosis will be dismal. It is very important to perform a complete physical examination and a global anamnesis to guide the request for diagnostic tests. Once the diagnosis of pancreatic adenocarcinoma has been made, a global assessment will be necessary, involving different medical specialists, nurses, psychologists and social workers among others. In many cases, supportive care is the mainstay of treatment.

Therapeutic Effect of Superficial Scalp Hypothermia on Chemotherapy-Induced Alopecia in Breast Cancer Survivors.

Alopecia is a common adverse effect of neoadjuvant or adjuvant chemotherapy in patients with early breast cancer. While hair typically regrows over time, more than 40% of patients continue to suffer from permanent partial alopecia, significantly affecting body image, psychological well-being, and quality of life. This concern is a recognized reason why some breast cancer patients decline life-saving chemotherapy. It is critical for healthcare professionals to consider the impact of this distressing side effect and adopt supportive measures to mitigate it. Among the various strategies investigated to reduce chemotherapy-induced alopecia (CIA), scalp cooling has emerged as the most effective. This article reviews the pathophysiology of CIA and examines the efficacy of different scalp cooling methods. Scalp cooling has been shown to reduce the incidence of CIA, defined as less than 50% hair loss, by 50% in patients receiving chemotherapy. It is associated with high patient satisfaction and does not significantly increase the risk of scalp metastasis or compromise overall survival. Promising new scalp cooling technologies, such as cryogenic nitrogen oxide cryotherapy, offer the potential to achieve and maintain lower scalp temperatures, potentially enhancing therapeutic effects. Further investigation into these approaches is warranted. Research on CIA is hindered by significant heterogeneity and the lack of standardised methods for assessing hair loss. To advance the field, further interdisciplinary research is crucial to develop preclinical models of CIA, establish a uniform, internationally accepted and standardised classification system, and establish an objective, personalised prognosis monitoring system.

Diagnosis and Management of Scalp Metastases: A Review.

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.

Trichology to predict efficacy of scalp cooling: New pathologic insights besides encouraging clinical results.

12093 Background: Chemotherapy continues to be an essential element of tumour-specific systemic therapy. The associated hair loss impacts patients ‘quality of life in addition. Sensor-controlled scalp cooling has proven itself as a method of preventing alopecia. This study evaluates the grade of hair preservation as well as predictive factors, including (ultra)structural changes of the hair follicle during treatment, offering potential for enhanced therapeutic strategies. Methods: Scalp cooling, was evaluated in 81 patients (79 women, 2 men, median age 56 years) undergoing breast carcinoma treatment (4x EC 90/600 mg/m² BSA followed by 12x PAC w). Key outcomes included hair preservation (Hair Mass Index = HMI), avoidance of visible hair loss (HMI ≥ 50), and prevention of severe hair loss (all measured by Cross Section Trichometer). Parameters such as hair density (HMI), trichologic parameters like hair shaft and bulb diameter, anagen rate, shaft surface damage and melanosomes changes were measured through (ultrastructural) microscopy. Results: Over the half (53%) of patients avoided successfully noticeable hair loss (HMI post ≥ 50). Most important predictors of successful hair preservation in different analyses included lower post-therapeutic shaft surface damage (via scanning electron microscopy) (β = -.30, p = .034), larger pre-treatment shaft diameter (via light microscopy) (OR = 1.11, p = .011), and stable melanosome density (via transmission electron microscopy) (β = .35, p = .013). Higher anagen ratio (β = .30, p = 0.009) and larger hair shaft diameter (β = .29, p=0,023) plays a crucial role in hair prevention, considering only light-microspcopic parameters. Comorbidity (OR = 0.12, p = .024) and alopecia causing medication (e.g. antihypertensiva) (β = -.31, p = .017) led to increased hair loss. Patients with fewer hair loss over the course reported higher quality of life (r = .25, p = .042) and lower psychological burden (r = -.42, p < .001). Data indicate that optimal pre-therapeutic hair density (HMI =/> 69), coupled with the absence of comorbidities and alopecia-inducing medications, substantially enhances the efficacy of scalp cooling, elevating the probability of preventing severe hair loss (HMI ≥ 50) by nearly sevenfold (OR = 6.98, CI95% [1.01;48.33]. Conclusions: Scalp cooling proves effective in preventing visible hair loss in 53% of patients, with mini-organ (hair follicle) characteristics influencing outcomes. It does not only prevent hair loss but also enhances quality of life, underscoring the need for personalized approaches in managing chemotherapy-induced alopecia. The study confirms the method's safety and effectiveness without increasing scalp metastasis risk.

Scalp metastasis in esophageal squamous cell carcinoma: A case report

This is a case of squamous cell carcinoma of esophagus presenting with scalp metastasis, metastatic esophageal cancer is associated with poor outcomes.

Inaugural Scalp Metastasis of Pulmonary Squamous Cell Carcinoma: A Rare Case Report and Literature Review

Distant cutaneous metastasis of primary lung squamous cell carcinoma is an exceedingly rare event, with scalp metastasis as the initial clinical presentation even rarer. Scalp skin metastases are prone to be misdiagnosed as other scalp disorders, yet their appearance signifies the deterioration and poor prognosis of lung cancer. This case report documents a female patient presenting initially with scalp folliculitis in dermatology, who was subsequently diagnosed with malignant lung tumor through radiological imaging and referred to Department of Thoracic Surgery. Pathological examination of the excised lesion from the scalp revealed distant metastasis of lung cancer. A review of similar cases reported in literature was conducted. This article aims to enhance understanding and awareness of skin metastasis in lung cancer, to emphasize the importance of this condition, and to improve early recognition and precise diagnosis. It is crucial to prevent clinical misdiagnosis and ensure appropriate treatment, finally leading to improve the prognosis of the patients. .

Scalp hypothermia for the prevention of chemotherapy-induced alopecia in breast cancer

Background. Breast cancer (BC) is a socially significant disease in women all over the world, ranking 1st in the structure and 5th in the number of deaths. Polychemotherapy in the complex treatment of BC accounts for approximately 80%. The main side effect that significantly affects the quality of life is alopecia, which occurs on average in 65% of patients.
 Aim. To evaluate the efficacy and tolerability of scalp hypothermia (SHT) for the prevention of chemotherapy-induced alopecia in patients with BC.
 Materials and methods. From June 2016 to September 2023, 75 patients with a median age of 44.1 years with stage I–IV BC were observed. All patients received cytotoxic therapy at various stages of treatment. To prevent alopecia, local SHT was used using an Orbis II device (Paxman Coolers, United Kingdom).
 Results. Stage I of the disease was observed in 18 (24%) patients, stage II in 22 (29.3%), stage III in 30 (40%), and stage IV in 5 (6.7%). Patients received 5 different neo- and adjuvant regimens of polychemotherapy. Taxane-containing combined regimens prevailed. 364 SHT sessions (4–8 sessions per patient) were performed; 48 (64%) patients received the procedure in full. Complete hair preservation was achieved in 43 (57.3%) patients. Grade 1 alopecia was observed in 19 (25.4%) patients and grade 2 in 9 (12%) patients. Of the 5 patients with advanced BC, grade 2 alopecia was reported in 1 patient, grade 3 in 3, and grade 4 in 1. Side effects were reported in 16% of cases; the most common were a feeling of cold and a slight headache. Due to the intolerance of the cold helmet, 3 patients refused to use it. No scalp metastases were observed during the follow-up. During the procedure, almost all patients noted a high level of comfort.
 Conclusion. Local SHT is an effective method of preventing cytotoxic therapy-induced alopecia in patients with BC. It improves the psychological and social adaptation of patients.

A Rare Presentation of Cutaneous Scalp Metastasis From a Malignant Phyllodes Tumor of the Breast: A Case Report and Literature Review

A Rare Presentation of Cutaneous Scalp Metastasis From a Malignant Phyllodes Tumor of the Breast: A Case Report and Literature Review

Cutaneous metastasis from cervical cancer to the scalp and trunk: a case report and review of the literature

BackgroundAn estimated 119,300 new cases of cervical cancer occur annually in China, accounting for 372,00 deaths. Cutaneous metastasis from cervical cancer is a rare event, with an incidence of 0.1–1.3% and typically a preterminal occurrence. Scalp metastasis from cervical cancer is exceptionally anecdotal, with only a dozen examples well documented.Case presentationThe patient is a 33-year-old Chinese woman who was diagnosed with International Federation of Gynecology and Obstetrics stage IVB cervical cancer in November 2021. From December 2021 to April 2022, the patient was enrolled in the clinical trial of sintilimab combined with chemotherapy and radiotherapy for treatment of stage IV cervical cancer and underwent six cycles of immunotherapy and chemotherapy (sintilimab plus paclitaxel liposome and cisplatin). Treatment was well tolerated and led to a partial response. The masses adjacent to the spine and iliac bone was largely reduced. Thus, radiotherapy of the metastatic residues was carried out and followed by radiotherapy to the primary tumor at the cervix uteri. However, by the time of the radiotherapy completion in October 2022, the patient noticed painless nodules at the left scapular region and the right hypochondrium. The following month, more nodules occurred on the scalp and trunk, including the left axilla, anterior abdomen, and left back, along with a lesion invading the sternum that caused acute bone pain. The cutaneous masses were white, discrete with a rubbery consistency, and fixed to the skin. Several nodules increased in size and eventually ulcerated. Fine‑needle aspiration cytology of the left back swellings revealed metastatic squamous cell carcinoma, P16 positive. No visceral or brain metastasis was observed at this point.ConclusionsCervical 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. So far, there is no clear guideline regarding skin metastases treatment. Such skin lesions warrant a thorough radiologic and pathologic workup to form a comprehensive management plan.

Synchronous Papillary and Follicular Carcinoma with Scalp and Nodal Metastasis: A case report with review of literature.

Collision tumor comprise of existence of two histologically distinct and separate neoplasms in any organ. Thyroid gland is an uncommon site for these tumors, with frequently involved organs being liver, adrenal and stomach. Even among the synchronous tumors of thyroid, papillary and medullary carcinoma are most commonly reported. The present case reports a rare presentation of a collision tumor comprising of papillary and follicular carcinoma with scalp metastasis from the follicular carcinoma and lymph nodal metastasis from the papillary component. It is essential for the clinician to be aware of such an entity so as to guide further treatment and management.

Nasal Alar and Scalp Metastases From Lung Carcinoma: A Case Report and Literature Review.

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.

Breast cancer with scalp metastases: a case report

BackgroundWhile 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 presentationA 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).ConclusionBreast 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.

A Rare Case of Scalp Metastasis from Encapsulated Angioinvasive Follicular Thyroid Carcinoma.

Cutaneous metastases from thyroid carcinomas are extremely rare; however, the scalp is a common site for cutaneous metastases from follicular thyroid carcinomas (FTCs). We report the case of a 77-year-old male patient with a blood-rich scalp lesion. Histopathological tests of punch biopsy specimens revealed subcutaneous well-formed follicular structures that were similar to those found in the thyroid gland. Immunohistochemistry using thyroid transcription factor-1 (TTF-1) and paired-box gene family 8 (PAX8) revealed an FTC metastasis. We performed total thyroidectomy and resection of the scalp lesion at the same time and administered postoperative radioactive iodine treatment. The primary thyroid lesion was diagnosed as an FTC based on extracapsular extension and vessel invasion. The patient has not experienced disease recurrence since the treatment. When scalp metastasis of thyroid carcinoma is suspected, we recommend total extirpation, including the primary tumor and scalp metastasis, for an improved prognosis.

A case of uterine carcinosarcoma with scalp metastasis

A case of uterine carcinosarcoma with scalp metastasis

A Scalp Metastatic Follicular Thyroid Carcinoma with a Silent Thyroid History and Normal Thyroid Uptake by PET-CT

Abstract Introduction/Objective Follicular thyroid carcinoma (FTC) accounts for 10%-15% of all primary thyroid cancers. Follicular thyroid cancer is known to metastasize hematogenously, with distant metastasis occurring in 6-20% of cases. Scalp metastasis with an underlying thyroid carcinoma is an exceedingly rare clinical entity; there are less than 15 case reports in the literature. 1-2. Here, we present a case of widely invasive FTC with skull metastases located on the parietal calvarium. The scalp mass was confirmed as follicular thyroid carcinoma via microscopic morphology and positive immunoreactivity for Vimentin, TTF1, thyroglobulin, and PAX8. We present this case not only because of the diagnostic challenge and rare scalp metastasis, but also because of the patient’s unusual “silent” thyroid medical history and no abnormal thyroid uptake by PET-CT. Methods/Case Report 81-year-old female presenting 2-year history of right parietal scalp mass, which was previously suspected for lipoma with attempted resection in Mexico but interrupted due to severe hemorrhage. No palpable thyroid nodule was noted. PET-CT showed avid lesions of the right breast with nipple retraction, as well as avid suspicious lesions of bilateral lungs, calvarium, xiphoid process, right acetabulum, T spine most c/f widely metastatic cancer, most likely a breast primary; evaluation of the neck demonstrates physiologic FDG-activity in the thyroid. Thyroid studies showed hyperthyroidism: TSH (L) <0.010 uIU/mL; Free T3 (H) 4.7 pg/mL and Free T4 1.00 ng/d. The patient was performed Ultrasound-guided FNA and core biopsy of the large parietal scalp lesion, however, FNA of the cystic component was nondiagnostic (no malignant cells seen). Results (if a Case Study enter NA) NA. Conclusion Core biopsy of the large parietal mass the tumor cells tend to form follicular or microfollicular architecture with colloid present, but no papillary nuclear features. Rare mitotic figures are seen. IHC stain of tumor cells are positive for AE1/AE3, Cam5.2, CK7, TTF1, thyroglobulin, PAX8, and Vimentin, which show strong evidence for metastatic follicular thyroid carcinoma (FTC) origin. Tumor cells are negative for Napsin-A, P63, Synaptophysin, Ck5/6, Ck20, EMA, WT1, CDX2, GATA3, Mammaglobin, ER, PR, and BRST2, which helps rule out the primary malignancy from lung, breast, neuroendocrine or other adenocarcinomas.

Isolated Skull Metastasis as first presentation of possible primary from Lung

Skull or scalp metastasis is commonly seen in carcinoma of breast, prostate, kidneys and lungs. Here we report a case of 80-year-old male who presented with scalp swelling for treatment. High resonance ultrasonography (HRUS) and contrast-enhanced computed tomography (CECT) of brain showed large soft tissue lesion on right occipito-parietal region with erosion of underlying bone, suggestive of neoplastic etiology. Subsequently, on further workup, his CT thorax showed lesion in right hilar and lower lobe of right lung with mediastinal lymph nodes. Patient underwent excision of the right occipito-parietal lesion which on histopathology was reported as epithelial malignancy, favoring metastatic moderately differentiated squamous cell carcinoma. This case is reported here to emphasize the importance of good clinical workup to rule out metastatic lesions which might be the initial presentation of an unknown primary at other site.

1578P Scalp cooling system for prevention of chemotherapy induced alopecia: A single center one-year prospective observational study

Alopecia is one of the most common and emotionally distressing side-effects of chemotherapy. Scalp cooling systems are commonly used to prevent chemotherapy induced alopecia. We are presenting our one-year experience with Paxman scalp cooling system. This is a prospective observational study in patients who started scalp cooling while undergoing chemotherapy for various cancers at our center from 1st November 2020 to 31st October 2021 to assess the efficacy, compliance and safety of scalp cooling system. Efficacy was defined by grading alopecia according to the Common terminology criteria for adverse events V4.0, independently by a clinician and a nurse. Withdrawl of patient from scalp cooling anytime after 1st session was defined as failure. A total of 128 patients underwent total 730 scalp cooling sessions. The mean age was 49 years with 123 females and 5 males. Eight patients were on palliative chemotherapy. Breast Cancer (58%) and Ovarian Cancer (23%) patients most commonly utilized scalp cooling system. We had 29% failure or drop-out while 71% were compliant. Among 37 patients who dropped-out, 29 dropped-out after the 1st cycle itself. The most common cause of failure was Grade II alopecia and patient dissatisfaction (25 patients out of which 20 had recieved anthracyclines) followed by cold intolerance (6) and missing scalp cooling due to logistic issues (6). Three patients used scalp cooling successfully while on multi-day chemotherapy. Post anthracycline-based chemotherapy, alopecia grading at the completion showed Grade 0 - 5%, Grade I - 25%, Grade II- 75%. Post taxane-platinum doublet, alopecia grading was- Grade 0 - 30%, Grade I- 58% and Grade II- 12% and after single agent taxane - grade 0 - 60%, grade I- 40%, grade II- nil. The common adverse events reported was chills (8%) , headache (4%) and skin erythema and itching (1%). No serious adverse events or scalp metastasis was observed. Scalp cooling is safe and effective system for reducing chemotherapy induced alopecia with good compliance and patient satisfaction rates. Efficacy is highest for taxanes and platinum-based chemo while poorest for anthracyclines.

Cancer-Related Alopecia: From Etiologies to Global Management.

Simple SummaryAlthough it does not represent a condition that threatens the life of patients, alopecia nevertheless has an essential impact on the quality of life of patients, particularly in terms of the psychological and social aspects. Indeed, while it has long been considered an acceptable side effect in the management of patients, the progressive emergence of a patient-centered approach coupled with a better knowledge of the pathophysiological processes involved has led to a better consideration of alopecia, both on the preventive and palliative sides. Thus, cancerous alopecia can be multifactorial: iatrogenic (in particular via conventional chemotherapy), induced by a vitamin/nutritional deficiency, or even caused by the disease itself. In this state-of-the-art review, we therefore cover alopecia in an exhaustive manner by considering the different mechanisms involved and their frequency as well as the various therapies offered. Alopecia represents a multifaceted challenge with distinct etiologies and consequences. Transposed to the world of oncology, different types of alopecia and molecular pathways have been characterized, allowing a better understanding of the underlying mechanisms. In patients with cancer, alopecia can be iatrogenic (i.e., due to conventional chemotherapies, endocrine therapies, targeted therapies, immunotherapies, radiotherapy and surgery) or a direct consequence of the disease itself (e.g., malnutrition, scalp metastases and paraneoplastic syndromes). Identification of the actual incriminated mechanism(s) is therefore essential in order to deliver appropriate supportive care, whether preventive or curative. On the preventive side, the last few years have seen the advent of the automated cooling cap, a prophylactic approach supported by several randomized clinical trials. On the curative side, although the treatments currently available are limited, several promising therapeutic approaches are under development. Appropriate alopecia management is essential, particularly regarding its psychological repercussions with significant consequences on the quality of life of patients and their family and with a potential impact on treatment compliance.

An Uncommon Case of Colonic Neuroendocrine Carcinoma with Scalp Metastasis

Abstract Introduction/Objective Neuroendocrine neoplasms of the colon account for <1% of all colorectal malignancies. While visceral metastasis of neuroendocrine neoplasms is commonly observed, cutaneous distant metastasis has infrequently been reported and correlates with an advance stage and progression of disease. To our knowledge, there have been only 10 cases of neuroendocrine neoplasms with metastasis to the scalp reported in the literature. Herein, we report an unusual case of colonic neuroendocrine carcinoma with scalp metastasis, that can be microscopically indistinguishable from the highly aggressive cutaneous neuroendocrine carcinoma, Merkel Cell Carcinoma. Methods/Case Report A 47-year-old female with a history of ileocecal neuroendocrine carcinoma and status post right hemicolectomy had developed liver metastasis and subsequently had an orthotopic liver transplant. PET scan later revealed multiple areas of increased activity involving the ribs, scalp and cervical lymph node that were concerning for malignancy. The scalp lesion consisted of a 7mm non-tender, mobile, violaceous, erythematous dermal nodule that was clinically concerning for cutaneous metastasis. A skin punch biopsy microscopically revealed a subcutaneous infiltrate of nests composed of neoplastic monotonous blue cells with the classic nuclear “salt and pepper” chromatin and scant eosinophilic cytoplasm. The lesional cells showed positive immunoreactivity for synaptophysin and chromogranin. With the given patient’s clinical history and presentation, the observed histological findings and immunophenotypic expression of the tumor cells supported a diagnosis of metastatic neuroendocrine carcinoma. Results (if a Case Study enter NA) N/A Conclusion Metastatic neuroendocrine carcinoma to the scalp is a rare entity and is infrequently encountered in dermatopathology. Given the location and the gross appearance of the scalp lesion, a wide differential diagnosis would include both benign and malignant tumors. In particular, Merkel Cell Carcinoma can grossly and histologically mimic metastatic colonic neuroendocrine carcinoma. Both entities would show synaptophysin and chromogranin uptake. However, metastatic tumors originating from the colon will demontrate CDX2 and SATB2 nuclear staining. We share this rare case of metastatic colonic neuroendocrine carcinoma as it is an important differential diagnosis for primary cutaneous Merkel Cell Carcinoma.

Endometrial carcinoma metastatic to the scalp

Endometrial carcinoma is a very rare cause of cutaneous metastasis. The most frequent presentations of cutaneous metastasis are fast developing nodules or tumors, which are evidence of widespread dissemination in such patients. We report a case of scalp metastasis from an endometrial adenocarcinoma with a fatal prognosis.