Scalp Metastasis as the First Sign of Small-Cell Lung Cancer: Management and Literature Review

Abstract

Cutaneous metastasis from primary visceral malignancy is a relatively uncommon clinical entity, with a reported incidence ranging from 0.22% to 10% among various series. However, the presence of cutaneous metastasis as the first sign of a clinically silent visceral cancer is exceedingly rare. We describe here a case of an asymptomatic male patient who presented with a solitary scalp metastasis as the initial manifestation of an underlying small-cell lung cancer. Diagnostic evaluation revealed advanced disease. We conclude that the possibility of metastatic skin disease should always be considered in the differential diagnosis in patients with a history of smoking or lung cancer presenting with cutaneous nodules. Physicians should be aware of this rare clinical entity, and appropriate investigation should be arranged for early diagnosis and initiation of the appropriate treatment. The prognosis for most patients remains poor.

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

“…A range from 0.22% to 10% of all metastatic lesions has been reported in literature for cutaneous metastasis from primary visceral tumours . Concerning the type and location of the associated primary visceral tumour, data are discordant.…”

“…Scalp represents a common site for cutaneous metastasis, accounting for 4% to 7% of all cutaneous metastasis from visceral tumours, which could be explained by the higher blood supply of this area, compared to other body regions . In this regard, the higher blood supply in the scalp could also clarify the red/violaceous appearance of AN.…”

“…In this regard, the higher blood supply in the scalp could also clarify the red/violaceous appearance of AN. On the contrary, regarding primary scalp tumours, they account for only 2% of all skin tumours and usually originate from the pilo‐sebaceous unit, the inter‐follicular epidermis or the dermis …”

Subcutaneous metastasis after three surgeries for brain metastasis from lung cancer: A case report and review of the literature

“…According to the published literature, the overall incidence of cutaneous metastasis is 2.9–5.3% (4), and 1–12% in lung cancer (2,5–8). Cutaneous metastasis usually presents as solitary or multiple nodules sized 5 mm-10 cm that are firm, immobile and covered with normal skin.…”

“…Subcutaneous metastasis from lung cancer has been well described (2); however, reports of subcutaneous metastasis of lung cancer after three surgeries for recurrent brain metastasis are scarce. We herein report a rare case of subcutaneous metastasis from pulmonary adenocarcinoma and provide a brief review of the relevant literature.…”