Alopecia neoplastica as a sign of visceral malignancies: a systematic review

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.

Current Diagnosis and Treatment Options for Cutaneous Adnexal Neoplasms with Follicular Differentiation

“…Macroscopic presentation of each of presented tumor is unspecific, what means that histological examination is required. Differential diagnosis includes BCC, SCC, sebaceous carcinoma, angiosarcoma, clear cell hidradenocarcinoma, other lesions located on the skin, especially other appendageal neoplasms and alopecia neoplastica [ 1 , 37 ]. Dermatoscopy is not recommended for diagnosis because of the unspecific manifestation of each tumor (most lesions have abnormal vascular patterns, areas of calcification, or keratin masses) [ 103 ].…”

“…Immunohistochemical markers, such as Ki-67, P53, AE13, AE14, and CD34, may help differentiate PTT with squamous cell carcinoma (SCC) [ 35 , 36 ]. It should be distinguished mainly from other neoplasms, which may be located in this region, and alopecia neoplastica (a rare form of skin metastasis in which internal malignancies spread to the scalp) [ 37 ]. Invasion of the surrounding tissue may be present.…”

Cutaneous metastasis as the first sign of renal cell carcinoma – crossroad between literature analysis and own observations

“…It was observed that the most common place of the primary tumour was the gastrointestinal tract, followed by breast, kidney, lung, thyroid, uterus, central nervous system, and liver [11]. The authors indicated that in the patients with localized scarring alopecia one always ought to remember about metastatic skin disease [11]. The most frequent site for skin metastasis of RCC has not been found yet.…”

Breast Cancer-Related Neoplastic Alopecia: A Case Report and Review of the Literature

“…Compression created in the dermis by tumoral mass itself could compromise survival and development of pilosebaceous units. This would explain the fact that sometimes hair regrew after proper cancer treatment [12,[30][31][32].…”

“…Attempts have been made to understand if there is a correlation between metastatization to the scalp and the histological type of primitive neoplasia. Few data available seem to highlight that adenocarcinoma is the subtype that most frequently associates with AN, perhaps because of the high density of glands in the scalp [32]. However, adenocarcinoma is the most frequent histologic subtype of breast cancer too.…”