This patient underwent wide local excision of the scalp mass with Integra-based reconstruction. The pathologic diagnosis was: Sarcomatoid squamous cell carcinoma with liposarcoma-like and pleomorphic sarcoma-like heterogeneous components.

Malignant tumors of the scalp are rare. When small in size, it may be covered by hair which may lead to delayed detection ¹. CT is helpful to evaluate skull invasion, and MRI might be helpful to delineate intracranial invasion, including involvement of the dura mater and superior sagittal sinus. Differential diagnosis includes melanoma, sebaceous carcinoma of the scalp ², head and neck sarcoma, and invasive proliferating trichilemmal cyst.

Fortunately, this patient had no skull or intracranial invasion. No metastases were found. He has a favorable outcome after surgery.