Scalp metastases as first presentation of pulmonary adenocarcinomas: a case report

Abstract

Qian Yu,1,2,* Smriti Subedi,1,2,* Yunlei Tong,1,2 Qing Wei,3 Hui Xu,1,2 Yao Wang,1,2 Yu Gong,1,2 Yuling Shi1,2 1Department of Dermatology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, People’s Republic of China; 2Institute of Psoriasis, Tongji University School of Medicine, Shanghai 200072, People’s Republic of China; 3Department of Pathology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, People’s Republic of China *These authors contributed equally to this work Abstract: Cutaneous metastasis from primary visceral malignancy is a relatively uncommon clinical entity, with a reported incidence ranging from 0.22% to 12% of all malignancies. Here we report a 64-year-old asymptomatic female patient with Peutz–Jeghers syndrome presenting with multiple scalp metastases as the initial manifestation secondary to lung adenocarcinoma. Subsequent lung computed tomography scan showed large masses involving the left upper lobe associated with extensive mediastinal lymphadenopathy. After treatment with an epidermal growth factor receptor inhibitor gefitinib, the size of the tumor in the lung reduced significantly and the condition of the patient also gradually improved. Our case demonstrated that scalp metastasis could be the first sign of an internal malignancy. Asymptomatic elderly patients presenting with multiple, painless, immobile cutaneous nodules should be considered for further investigations to rule out the underlying primary cause. Metastasis to the skin is often a preterminal event that heralds poor prognosis. Keywords: cancer, metastasis, scalp, lung adenocarcinoma

Keywords

• Cancer
• Metastasis
• Scalp
• Lung adenocarcinoma