Presentation
Scalp mass for 10 years, slowly growing in size, but increasing more rapidly over the last 6 months with bleeding.
Patient Data
Centered in the left scalp near the vertex, there is a large multilobulated heterogeneous soft tissue mass. The lesion contains fat density components as well as coarse/punctate calcifications. This measures up to 12 cm in the oblique craniocaudal dimension. The mass extends to the outer table of the calvarium, but no osseous invasion or periosteal reaction is seen.
Post contrast images demonstrate numerous bilateral (right and left) feeding vessels and avid enhancement of portions of the lesion.
Photo of the back of the head demonstrates a very large multilobulated mass arising from the left scalp. There is irregularity and heterogeneity of the surface of the mass.
Case Discussion
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.