Chapter 18

Scalp Tumors
Antonella Tosti, Massimiliano Pazzaglia, Bianca Maria Piraccini 18
  Synonyms 6
skin cancer of the scalp, hair follicle associated tu-
mors

  Key Features

• Approximately 2% of all skin tumors are located on • Malignant tumors are rare.
the scalp. • Scalp tumors can be primary skin tumors or sec-
• Frequency increases with ageing. ondary, metastatic manifestation of other tumors.

Contents

18.1 Introduction  . . . . . . . . . . . . . . . . . . . . . . . . .   380 18.9.1 Scalp Metastases from Lung Cancer   . . . .   385
18.2 Tumors of the Pilosebaceous Unit 18.9.2 Scalp Metastases from Breast Cancer   . . . .   385
on the Scalp [22]  . . . . . . . . . . . . . . . . . . . . .   380 18.9.3 Scalp Metastases from Colon Cancer   . . . .   385
18.2.1 Trichoepithelioma  . . . . . . . . . . . . . . . . . . . .   380 18.9.4 Scalp Metastases from Gastric Cancer   . . .   385
18.2.1.1 Treatment Options  . . . . . . . . . . . . . . . . . . .   380 18.9.5 Scalp Metastases from Renal Cancer   . . . .   385
18.2.2 Pilomatrixoma  . . . . . . . . . . . . . . . . . . . . . . .   380 18.9.6 Scalp Metastases from Esophageal
18.2.2.1 Treatment Options  . . . . . . . . . . . . . . . . . . .   380 Carcinoma   . . . . . . . . . . . . . . . . . . . . . . . . . .   385
18.3 Sebaceous Nevus  . . . . . . . . . . . . . . . . . . . . .   381 18.9.7 Treatment Options  . . . . . . . . . . . . . . . . . . .   385
18.4 Actinic Keratosis  . . . . . . . . . . . . . . . . . . . . .   381 18.10 Metastatic Carcinoma of the Scalp  . . . . . .   385
18.4.1 Treatment Options  . . . . . . . . . . . . . . . . . . .   382 18.10.1 Treatment Options  . . . . . . . . . . . . . . . . . . .   385
18.5 Basal Cell Carcinoma  . . . . . . . . . . . . . . . . .   382 18.11 Lymphomas  . . . . . . . . . . . . . . . . . . . . . . . . .   386
18.5.1 Treatment Options  . . . . . . . . . . . . . . . . . . .   382 18.11.1 Non-Hodgkin’s Lymphomas  . . . . . . . . . . .   386
18.6 Squamous Cell Carcinoma  . . . . . . . . . . . . .   383 18.11.2 Mycosis Fungoides, Follicular Mycosis
18.6.1 Treatment Options  . . . . . . . . . . . . . . . . . . .   383 Fungoides and Sézary Syndrome  . . . . . . . .   386
18.7 Primary Melanoma of the Scalp  . . . . . . . .   383 18.11.3 Follicular Mucinosis  . . . . . . . . . . . . . . . . . .   386
18.7.1 Lentigo Maligna  . . . . . . . . . . . . . . . . . . . . . .   384 18.12 Scalp Hemangiomas  . . . . . . . . . . . . . . . . . .   387
18.7.2 Desmoplastic Melanoma  . . . . . . . . . . . . . .   384 18.13 Epidermoid Cyst  . . . . . . . . . . . . . . . . . . . . .   387
18.7.3 Treatment Options  . . . . . . . . . . . . . . . . . . .   384 Summary for the Clinician  . . . . . . . . . . . . .   387
18.8 Angiosarcoma  . . . . . . . . . . . . . . . . . . . . . . .   384
18.8.1 Treatment Options  . . . . . . . . . . . . . . . . . . .   384 References   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   387
18.9 Scalp Metastases  . . . . . . . . . . . . . . . . . . . . .   384
 380 Antonella Tosti et al.  

syndrome (BSS) caused by mutations of the cylindro-

18.1 Introduction
matosis oncogene (CYLD), which maps to 16q12-q13.
Clinically, TE appears as slow-growing, skin-colored
Scalp tumors are skin cancers that can derive directly single or multiple papules or nodules, 2–8 mm in di-
from the hair follicle epithelium, from the interfollicular ameter, usually on the face. Most lesions show slow
epidermis or from other cell types. Thus, scalp tumors growth.
can be classified as tumors arising from the pilosebaceous
unit with a differentiation pattern that depends on the
cell population from which they originated (sebaceous, 18.2.1.1 Treatment Options
endothelial, epithelial, pigmented cells, fibroblasts, etc.),
as tumors arising from the interfollicular epidermis or The treatment of TE is primarily surgical.
dermis or as metastases from other tumors.
Skin cancer of the scalp occurs most often in balding
and elderly men who have had intense sun exposure, but 18.2.2 Pilomatrixoma
they can also occur in humans with a full head of hair or
rarely also in genodermatoses. Synonyms 6
Rarely, other types of cancer can metastatize to the
 

calcifying epithelioma of Malherbe, Malherbe epi-

scalp and early detection is the key to successful man-
thelioma, trichomatrioma, benign calcifying epithe-
agement. The following most frequent scalp tumors
lioma, hair cell tumor, Malherbe tumor, pilomatrix
can be distinguished: sebaceous nevi, actinic keratoses,
epithelioma, pilomatrix tumor, pilomatrical neo-
basal cell carcinoma, squamous cell carcinoma, mela-
plasm, pilomatrix carcinoma, myotonic dystrophy,
noma, angiosarcoma, scalp metastases or metastatic
hair matrix cell tumorigenesis, hair matrix cell tu-
carcinoma of the scalp. Lymphoma or hemangioma can
mor, trichoadenoma
also be present on the scalp.

  Key Features
18.2 Tumors of the Pilosebaceous
Unit on the Scalp [22]
• Benign adnexal tumors originating from hair ma-
trix cells.
Tumors of the pilosebaceous unit on the scalp are rare, • Frequently occur in children.
and have nonspecific clinical aspects, the most common • May be associated with syndromes.
being trichoepithelioma and pilomatrixoma.
 

18 18.2.1 Trichoepithelioma A pilomatrixoma is a benign appendageal tumor with

differentiation toward hair cells, common in children,
Synonyms 6 usually becoming evident in the first 2 years of life. Pi-
lomatrixoma usually manifests as a solitary, asymptom-
 

Brooke–Spiegler syndrome
atic, firm nodule in the head and neck, especially the
cheek, preauricular area, eyelids, forehead, scalp, and
lateral and posterior neck. In ~3% of children piloma-
  Key Features trixoma occur in a multiple manifestation. It is impor-
tant to know that these multiple pilomatrixoma can be
• Benign adnexal. associated with different syndromes: myotonic dystro-
• 50% on scalp and face. phy Curschmann-Steinert, Gardner Syndrome, Rubin-
• May be isolated but most frequently occur in mul- stein–Taybi syndrome, sarcoidosis, Turner syndrome,
tiples. and Cleidocranial dysostosis.

18.2.2.1 Treatment Options

Trichoepithelioma (TE) is a benign adnexal neoplasm
that typically occurs in young to aging adults. The gene Spontaneous regression has never been observed. The
involved in the familial form of TE is located on band treatment of choice is surgical excision. If the clinical di-
9p21. Other cases are associated with Brooke–Spiegler agnosis is not clear, fine needle aspiration cytology can