Scalp Metastasis Research Articles

Pili Torti: A Feature of Numerous Congenital and Acquired Conditions.

Pili torti is a rare condition characterized by the presence of the hair shaft, which is flattened at irregular intervals and twisted 180° along its long axis. It is a form of hair shaft disorder with increased fragility. The condition is classified into inherited and acquired. Inherited forms may be either isolated or associated with numerous genetic diseases or syndromes (e.g., Menkes disease, Björnstad syndrome, Netherton syndrome, and Bazex-Dupré-Christol syndrome). Moreover, pili torti may be a feature of various ectodermal dysplasias (such as Rapp-Hodgkin syndrome and Ankyloblepharon-ectodermal defects-cleft lip/palate syndrome). Acquired pili torti was described in numerous forms of alopecia (e.g., lichen planopilaris, discoid lupus erythematosus, dissecting cellulitis, folliculitis decalvans, alopecia areata) as well as neoplastic and systemic diseases (such as cutaneous T-cell lymphoma, scalp metastasis of breast cancer, anorexia nervosa, malnutrition, cataracts, and chronic graft-vs.-host disease). The condition may also be induced by several drugs (epidermal growth factor receptor inhibitors, oral retinoids, sodium valproate, and carbamide perhydrate). The diagnosis of pili torti is based on trichoscopic or microscopic examination. As pili torti is a marker of numerous congenital and acquired disorders, in every case, the search for the signs of underlying conditions is recommended.

Clinical Oncology Research and Reports (E-ISSN: 2693-4787) Dear Dr. Wilma D. Heemsbergen, Greetings! I am writing this email to introduce our Journal “Clinical Oncology Research and Reports” due for release our upcoming issue in the End of May. We have just gone through your published manuscript which was quite interesting “Breast-shape changes during radiation therapy after breast-conserving surgery” so we

Extracranial metastases from glioblastoma multiforme (GBM) are rare, especially cutaneous metastasis. However, the metastatic mechanism of GBM remains unknown with no current consensus regarding the best therapeutic regimen. We report the clinical, imaging and pathological features of a case of a 47 years old man with primary glioblastoma; who 12 months after receiving a macroscopically total resection and adjacent radiotherapy, developed scalp metastasis and subsequent multiple skin metastasis. We also discuss the details of this case in comparison with the previously reported cases in literature in terms of clinical presentation, lesions’ site, management and survival.

Cutaneous scalp metastases from a left hallux subungual melanoma: An instructive case of scalp nodules

Melanoma is the most aggressive form of skin cancer affecting patients worldwide and has the potential to metastasize to virtually any organ in the body. Early detection is of paramount importance to minimize patient morbidity and mortality. However, there has been increasing evidence highlighting that geographical and ethnic variations in the clinical presentation of melanoma do exist. Unlike the Western population, the major subtype of melanoma affecting the Asian population is in fact, acral lentiginous melanoma (ALM) and not superficial spreading melanoma (SSM).We hereby present a case of left hallux subungual melanoma with scalp metastasis. This case underscores the importance of the examination of acral skin and the nail apparatus for melanoma in Asians.

Mezotelyoma'nın Saçlı Deri Metastazı

Mesothelioma is a primary malignant tumor of the mesothelial cells lining the pleura, pericardium and peritoneum, which is frequently seen between the ages of 40-60. Malignant mesothelioma (MM) is a rare neoplasm with a poor prognosis, usually associated with asbestos exposure. It is characterized by aggressive local invasion and metastatic spread. Extrathoracic lymphogenous-hematogenous metastases are rare at the time of diagnosis and in the early stage. However, metastases develop in at least half of the cases in the late stage of the disease. After the spread of serous membranes, distant metastases to the bone, adrenal gland, and liver are frequently observed. Skin and scalp metastases are rarely observed. Our case MPM is presented because it is a rare scalp metastasis.

Scalp metastases as the first sign of a breast carcinoma.

Scalp metastases as the first sign of a breast carcinoma.

Safety and efficacy of scalp cooling system in preventing chemotherapy induced alopecia - A single center prospective study

BackgroundAlopecia is one of the most common and afflicting side effects associated with chemotherapy treatments. Scalp-cooling devices were introduced to reduce hair loss and improve the hair volume recovery in patients undergoing chemotherapy. MethodsThis is a single center, prospective observational study conducted from 01 February 2019 to 31 January 2020, in patients undergoing chemotherapy for various cancers. The extent of alopecia was assessed by two independent clinicians by reviewing the photographs taken at baseline, during each session, and 4 weeks from the last scalp cooling session. ResultsA total of 100 patients (female: 94 and male: 6) were enrolled in the study, with a mean age of 53.5 years. Of 100 patients, 40 received anthracycline based chemotherapy, 45 received taxane based chemotherapy, 9 received both, and 6 received other chemotherapeutic agents. By the end of the study, 31 patients experienced grade 0–1 alopecia and 69 patients had grade 2 alopecia. On multivariate analysis, chemotherapeutic agent was found to be an independent factor for delaying the onset of Grade 2 alopecia (anthracycline vs taxanes (OR: 0.71; 95% CI (0.51–0.92); P ≤ 0.04)The most common adverse events reported during the scalp cooling sessions were chills (7%), and chills with headaches (6%). Scalp metastasis and scalp cooling discontinuation rates were observed to be very rare. No serious adverse events related to device were observed. ConclusionScalp cooling was observed to be more effective in reducing chemotherapy-induced alopecia in patients treated with taxane-based chemotherapy over anthracyclines. Scalp cooling sessions were well tolerated. Scalp metastasis and scalp cooling discontinuation was observed to be very rare.

Unusual Metastases Site of Thyroid Papillary Carcinoma: A Case Report and Review of the Literature

Thyroid carcinoma with cranial scalp metastasis is an unusual site. Although these metastases have poor prognosis, early diagnosis and administration of accurate therapy using radioactive iodine seems likely to improve the survival rate and the quality of life. We report a case of a 50-years old woman presented to our ENT department with a slowly evolving lesion in the subcutaneous tissue of the skull occurred 10 years after right lobo-isthmectomy. The treatment was based on resection of the skull lesion as well as thyroid totalization and radioactive iodine

Is scalp cooling system effective in chemotherapy induced alopecia? A real-world experience in Asian patients.

e19334 Background: Chemotherapy induced alopecia(CIA) is the most common and afflicting chemotherapy side effect. Data on the use of scalp cooling (SC) to prevent CIA is limited and debatable due to lack of experience. This study analyzed the effectiveness and tolerability of SC in clinical practice. Methods: We prospectively analysed 100 consecutive patients who opted for Paxman scalp cooling. The assessment of alopecia was done by WHO grading system. The extent of alopecia was analyzed at baseline, during each session, and 4 weeks from the last SC session. Results: A total of 100 (94 females, 6 males) patients were enrolled. Amongst them, 69% had breast cancer, 18% had ovarian cancer and 26% had various other cancers. Majority of patients were treated with a curative intent (69%) and had a good performance status (ECOG PS 0-1). Overall 40% patients received anthracyclines, 45% received taxanes, 9% received both and 6% patient received other chemotherapeutic agents. Hair preservation rate was in 31% (Grade 0 alopecia 12%, Grade 1 alopecia 19%). After a single SC session, 30% of patients discontinued due to grade 2 alopecia. On cox regression analysis, onset of grade 2 alopecia on SC was significantly longer in patients on taxanes compared to anthracyclines (1.357 HR, 0.98-1.87 CI, p= .05). One out of 100 patients developed scalp metastases. Majority of the patients experienced mild side effects [chills (30%), headache (12%)]. One out of 100 patients discontinued SC due to intolerable side effects. None of the other predetermined factors (age, menopausal status, ECOG performance status, body mass index), were found to delay the onset of grade 2 alopecia amongst the male patients, hair preservation rate was 100% . Conclusions: Scalp cooling is very effective for hair preservation for some chemotherapy patients. In our study, we found that it is more effective in reducing alopecia in taxane chemotherapy. Scalp metastasis and SC discontinuation were observed to be very rare.

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.

Scalp Metastasis of Cervical Cancer With Favorable Outcome

Introduction: Carcinoma of the uterine cervix is the most common gynecological malignancies in developing countries. Human papilloma virus is known as the main etiology. In addition, the spread of uterine cervical cancer often occurs through direct local extension and the lymphatics although the hematogenous spread is uncommon. Further, the scalp metastasis of cervical cancer is extremely rare. Case Presentation: In this regard, a 50-year-old woman with scalp metastasis of previous cervical cancer was discussed in the present study. She was suffering from a fast-growing and painful nodule, located on the frontal part of the scalp as a sole site of metastasis. A multidisciplinary approach was considered for her, which consisted of radical excision, followed by radiotherapy and chemotherapy. Given the lack of abundant evidence for the efficacy of this treatment, our patient has fortunately survived for more than two years. Conclusions: During the follow-up period after the completion of treatment, it is not sensible to only focus on the primary site of the tumor and thus entire examination is mandatory in this regard.

Scalp Metastasis as an Initial Presentation of Lung Cancer: A Case Report

Introduction: Lung can be affected by various tumors, including lung carcinoma. These
 tumors exhibit certain clinical signs. In rare cases, they may appear unusual and affect the
 diagnostic and therapeutic course. Considering the importance of this issue, in the present
 study, we report a case of lung lymphoma with subsequent lump masses. We report a
 diagnostic evaluation in a male case with the first manifestation as an unusual presentation
 of scalp metastasis due to underlying lung cancer.
 Conclusion: Although lung cancer is typically presented in classical form, it is important to
 consider unusual manifestations of underlying lung cancer, along with the appearance of
 scalp lesions.

Gastric Cardia Adenocarcinoma with Metastasis to the Scalp: A Case Report

Cutaneous metastasis is a rare manifestation of advanced gastrointestinal (GI) cancers. Gastric adenocarcinoma rarely presents with cutaneous metastasis, as cutaneous manifestations occur in less than 1% of upper GI tract malignancies. Here, we present the case of a patient with advanced gastric cardia adenocarcinoma with metastasis to the right occipital region of the scalp. Following shave biopsy, the immunohistochemistry (IHC) and molecular profile of the scalp lesion were analyzed, both of which confirmed metastasis and guided the treatment approach. The lesion demonstrated programmed death ligand-1 (PD-L1), an immune checkpoint protein, positivity by IHC, which led to the recommendation for treatment with immunotherapy as per the National Comprehensive Cancer Network (NCCN) guidelines. Clinicians should conduct dermatologic examinations in patients with a history of gastric cancer or who are currently undergoing chemotherapy for gastric cancer in order to monitor for disease progression or metastatic lesions. The aim of this report is to increase awareness of scalp metastasis as an indicator of advanced internal visceral carcinoma for earlier diagnosis and improved management of the condition.

Breast Cancer Cutaneous Metastasis after Scalp Cooling for Alopecia Prevention

Scalp cooling is a widely used method to prevent chemotherapy-induced transient alopecia. Although the success rates in maintaining hair can be high, authors have expressed their concerns regarding the risk of scalp metastasis after scalp cooling. We report a case of breast cancer scalp metastasis in a patient submitted to scalp cooling for alopecia prevention and discuss the physiopathology, risks and benefits of this treatment for patients under this treatment.

Bilateral ovarian and scalp metastasis of breast cancer in a female patient after a year time treatment

Metastasis of breast cancer to distant organs are the most common causes of death in breast cancer cases. The most frequent metastatic sites of breast cancer include the liver, lung, bone, and brain. Some sites of metastasis are known to be less frequent while some sites are uncommon. Among them, ovaries are often reported and scalp is rarely reported. Although ovarian and scalp metastasis from breast cancer present diagnosis and therapeutic challenges, there is no consensus on the prognosis, monitoring, and treatment of such metastasis of breast cancer. In order to share our experience and discuss our management, we report a case of bilateral ovarian and scalp metastasis of breast cancer in a 39 years old female patient after a year time treatment

Scalp metastases in breast cancer

This paper describes a clinical case of scalp metastases in the setting of breast cancer. The data on the prevalence of the disease in Russia and the necessity of its early diagnostics is provided. The clinical picture and trichoscopic signs of neoplastic processes in the scalp are presented: alopecia foci of 1–3 cm in diameter; foci older than 6 months featuring erythematous and atrophic skin; nodes of the colour of healthy skin or with a yellowish tint sized 1 cm in diameter; trichoscopy — in the foci older than 6 months, the vascular structures are represented by point, thick and thin tree-like vessels. In connection with a poor prognosis for survival when skin metastases are detected, the onco-alertness of practitioners in relation to scalp metastases should be increased.Conflict of interest: the authors state that there is no potential conflict of interest requiring disclosure in this article.

Abstract P1-17-04: Long-term safety follow-up of patients with early stage breast cancer treated with scalp cooling on the Dignitana scalp cooling trial

Abstract Background Scalp cooling has demonstrated efficacy in preventing hair loss in women with early stage breast cancer receiving neo/adjuvant chemotherapy. Data from 2 prospective trials (Rugo et al, and Nangia et al, JAMA 2017) led to FDA clearance of 2 automated scalp-cooling devices to prevent chemotherapy induced alopecia (CIA). Although scalp metastases from breast cancer are rare, historical concerns about scalp cooling included a theoretical increase in risk of recurrence in scalp due to reduced delivery of chemotherapy to the scalp. Methods We conducted a multicenter prospective trial evaluating the efficacy and safety of the DigniCap in women with stage I-II breast cancer receiving neo/adjuvant chemotherapy excluding sequential or combination anthracycline/taxanes with concurrent matched controls. The primary endpoint was unblinded patient self-assessment of 5 photographs using the Dean scale to estimate hair loss 4 weeks following the last dose of chemotherapy, with success defined as a Dean score of 0-2 (≤ 50% hair loss); additional endpoints included quality of life (QOL) and both short and long-term safety. Results 106 patients using the scalp cooling device and 16 concurrent controls were enrolled. As previously reported, the use of scalp cooling was associated with less alopecia and improvement in several measures of QOL (Rugo et al, JAMA 2017). 91 patients have follow-up (FU) out to 3 years; 73 with estrogen receptor (ER) positive and 18 with ER negative disease. 5 DigniCap patients have developed recurrent breast cancer in breast (n=1), liver (n=1), bone, liver and breast (n=1), bone, liver, lung, and nodes (1), and bone, breast, GI tract and bladder (n=1). Of 12 control patients with available FU, 1 developed metastases to liver. 2 patients have died of metastatic disease, one in the DigniCap arm and one in the control arm. No new safety signals have been detected. Conclusion Scalp cooling using the DigniCap system in patients with early stage breast cancer receiving taxane based neo/adjuvant chemotherapy is safe and effective. No scalp metastases have been reported 3 years following completion of study treatment. 4 year FU data will be presented. The study was funded by The Lazlo Tauber Family Foundation (UCSF), the Anne Moore Breast Cancer Research Fund (Weil Cornell), and the Friedman Family Foundation (Mount Sinai Beth Israel), as well as partially by Dignitana. Citation Format: Rugo HS, Klein P, Melin SA, Hurvitz SA, Melisko ME, Moore A, D'Agostino, Jr. RB, Deluca A, Cigler T. Long-term safety follow-up of patients with early stage breast cancer treated with scalp cooling on the Dignitana scalp cooling trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-17-04.

Solitary scalp metastatic lesion as a sign of breast cancer recurrence—a case report

Scalp tumors are rare and account only for 2%. Nevertheless, the scalp region accounts for 4–6.9% of all cutaneous metastases. Metastatic cutaneous lesions are more often found in women with breast cancer than in those with other internal malignancies. Case report. A 59-year-old woman, who had been clinically diagnosed with stage-IIIA (T3 N2a M0) invasive ductal right breast carcinoma in August 2015, was treated by neoadjuvant chemotherapy with good partial response. Breast conservative surgery was done and she received post-operative adjuvant radiotherapy and hormonal treatment with letrozole. Two years later, the patient noticed a slowly growing, painless scalp nodule. A PET-CT scan was performed and demonstrated scalp mass at the left temporal region. Excisional biopsy was performed; histopathologic examination revealed poorly differentiated adenocarcinoma. In addition, detailed immunohistochemical staining was performed. Accordingly, patient was given radiotherapy and second line hormonal treatment was added, with disease-free survival of one year. Despite its rarity, solitary scalp metastasis should be considered in the differential diagnosis in patients with a history of cancer especially breast cancer.

Scalp Metastases as a Rare Primary First Manifestation of Gallbladder Cancer

Gallbladder cancer (GBC) with cutaneous metastases is a rare entity. Metastases on the scalp is even rarer and an unusual metastatic pattern of GBC. Only 12 cases have been reported so far. We herein report a case of a 52-year-old woman who presented with subcutaneous nodule over the scalp with pain in the right upper abdomen. Fine-needle aspiration cytology (FNAC) of this nodule revealed metastatic adenocarcinoma. Contrast-enhanced computed tomography scan of the abdomen showed an advanced GBC confirmed by FNAC from the gallbladder mass. She was put on palliative combination chemotherapy but rapidly developed multiple scalp nodules and jaundice with dramatic deterioration. This report highlights the possible scalp metastasis from advanced GBC that portends an ominous prognosis.

A Case of Scalp Metastasis from Breast Cancer without Other Distant Metastases

Cutaneous metastases of malignant tumors are relatively rare, and breast cancer is the most common malignancy in women with cutaneous metastases. Since newly developed cutaneous lesions can be the first signs of metastases in breast cancer patients, it is crucial to rule out the possibility of malignancy. Although only a few cases have been reported, breast cancer contributes to a large portion of scalp metastases. This case report demonstrates a rare case of breast cancer metastasis only confined to the scalp. The patient was a 55-year-old woman who was diagnosed with scalp metastasis from breast cancer 10 years after the first curative surgery. The scalp lesion was palpable for 4 years and showed a sudden increase in size over a few months. The patient underwent wide excision with flap coverage. After surgery the patient received radiotherapy, but she has refused additional hormonal therapy. To date, there is no evidence of disease recurrence. Keywords: Breast neoplasms; Neoplasm metastasis; Scalp dermatoses

A rare case of carcinoma rectum with scalp metastasis: an unusual presentation

Colorectal cancer is the third most commonly diagnosed cancer and third leading cause of cancer death in both men and women in the world. Metastasis is common in case of carcinoma rectum due to the late arrival of the patient to the doctor. The common sites for metastasis are liver, lung or ovary. But metastasis to the scalp is very rare. A 65-year-old female patient who presented to the casualty with sub-acute intestinal obstruction of four days duration was managed conservatively. Incidentally the patient noticed a swelling over the scalp which was initially of size 1 × 1 cm which progressed to the size of 3 × 3 cm over a period of 2 weeks. FNAC from the swelling showed features of skin adnexal tumor. Excision of the swelling was done, and histopathological examination revealed features of metastatic adenocarcinoma. Colorectal carcinoma can be controlled or treated with frequent screening of any individual who has crossed 50 years with occult stool for blood or by colonoscopy. In this way metastasis can be controlled if we treat at the early stages.