Cervical cancer metastasis to the scalp presenting as alopecia neoplastica

Abstract

A 45-year-old Japanese woman was diagnosed in 1996 with squamous cell cancer of the cervix following an abnormal Papanicolaou smear and subsequent diagnostic conization. She underwent total abdominal hysterectomy with pelvic lymphadenectomy and was found to have poorly differentiated squamous cell carcinoma, International Federation of Gynecology and Obstetrics (FIGO) stage IB1. She remained asymptomatic until 2003 when she presented with obstructive uropathy with acute renal failure and hydronephrosis, suspected to be from the recurrence of cervical cancer. This was confirmed when computerized tomography (CT)-guided lymph node biopsy showed squamous cell carcinoma of the para-aortic lymph nodes histologically consistent with the cervical primary. In addition, there was evidence of lumbar spine metastasis by positron emission tomography (PET) and bone scans. She received several courses of chemotherapy with cisplatin and 5-fluorouracil (5FU), as well as radiation therapy. In July 2004, she was hospitalized for acute renal failure, nausea, vomiting, and anorexia. CT of the abdomen identified widespread metastases in the liver, pancreatic head, and lumbar spine. During this hospitalization, she complained of severe scalp tenderness and patchy hair loss first noticed 3 days prior to presentation. On examination of her scalp, two patches of alopecia were observed (Fig. 1). In the largest patch, there was a 5 x 2.5-cm, tender, erythematous plaque with atrophy. In the smaller patch, there was a 2 x 1.5-cm, erythematous, scaly plaque. A punch biopsy of the larger patch revealed atypical epithelial cells in nests with intravascular involvement and diminished numbers of focally miniaturized hair follicles (Fig. 2a). The scalp specimen was histologically identical with biopsy specimens of the cervical primary (Fig. 2b). There was also seborrheic dermatitis, with thick greasy scale, noted on the scalp, which resolved with fluocinolone solution. The patient decided against further treatment for her advanced cervical cancer but did accept hydromorphone for pain. She died 3 months after admission.

Cutaneous Metastases From Internal Malignancies

“…[3][4][5]15,111,[251][252][253][254] The lesions may appear as multiple dermal and subcutaneous nodules, which are firm, tender, and nonulcerative, located on the chest, abdomen, vulva, 254 lower extremity, 15,252 and the face (Fig. 230,255 Sometimes, these skin lesions involve the umbilicus as another example of Sister Mary Joseph nodule. 230,255 Sometimes, these skin lesions involve the umbilicus as another example of Sister Mary Joseph nodule.…”

Scalp and skull bone metastasis in cervical carcinoma—a rare entity

“…Scalp metastasis is very rare, and, so far, has been previously reported in only eight studies, and suggests not being related to the initial stage of presentation as it is detected in patients treated in early stages as well as advanced (Table 1) [1,2,3,7,[9][10][11][12]. The spread that is probably explained through the hematogenous pathway, as tumour plungers that reach the branches of the external carotid artery, with the consequent local implantation [2].…”

Desmoplastic melanoma presenting as primary alopecia neoplastica: a report of two cases

“…Secondary alopecia neoplastica almost exclusively occurs in females with metastatic breast cancer being the most common etiology by far . Others causes of secondary alopecia neoplastica are more rare and include metastatic malignancies of pulmonary, gastrointestinal or reproductive system origins . A history of previous malignancy and/or the concomitant existence of distant metastases elsewhere may alert the provider to the neoplastic origin of alopecia in these cases.…”