Scalp Metastases Mimicking Alopecia Areata

Yuen, Yu‐Fahn; Lewis, Eric J.; Larson, Jeannie T.; Wilke, Mark S.; Rest, Ellen B.; Zachary, Christopher B.

doi:10.1111/j.1524-4725.1998.tb04211.x

Cited by 20 publications

(6 citation statements)

References 36 publications

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“…Secondary alopecia neoplastica almost exclusively occurs in females with metastatic breast cancer being the most common etiology by far . Others causes of secondary alopecia neoplastica are more rare and include metastatic malignancies of pulmonary, gastrointestinal or reproductive system origins . A history of previous malignancy and/or the concomitant existence of distant metastases elsewhere may alert the provider to the neoplastic origin of alopecia in these cases.…”

Section: Discussionmentioning

confidence: 99%

Desmoplastic melanoma presenting as primary alopecia neoplastica: a report of two cases

et al. 2016

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Desmoplastic melanoma is an uncommon form of melanoma characterized by atypical spindled melanocytes and abundant collagen deposition. It typically presents in sun-damaged skin of the elderly as an amelanotic, indurated lesion. It has a higher tendency for local recurrence but lower risk of lymph node metastasis vs. conventional malignant melanoma. We report two cases in women aged 59 and 66 who presented with small scalp lesions clinically suggestive of alopecia. The differential diagnosis included alopecia areata, lupus erythematosus and lichen planopilaris. Biopsies performed according to alopecia protocol were reviewed at our institutions. Biopsies revealed atypical spindled and nested epithelioid melanocytes set in a sclerotic dermis with scattered lymphoid aggregates and immunohistochemical expression of S100 protein, features diagnostic of combined desmoplastic melanoma. Wide local excision with skin graft was performed on the older patient. Excision showed combined desmoplastic melanoma with a Breslow thickness of 8.5 mm with melanoma in situ identified in the adjacent epidermis. The other patient sought treatment elsewhere and was lost to follow up. These cases illustrate desmoplastic melanoma as an unusual etiology and dangerous clinical pitfall in patients with scar-like alopecia. To the authors' knowledge, these represent the second and third reported cases of desmoplastic melanoma presenting as primary alopecia neoplastica.

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Section: Discussionmentioning

confidence: 99%

Desmoplastic melanoma presenting as primary alopecia neoplastica: a report of two cases

et al. 2016

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“…3 reported a case of alopecia neoplastica due to metastasis from gastric carcinoma, and Yuen et al . 4 reported a case in which the primary tumour was a placental trophoblastic tumour.…”

Section: Discussionmentioning

confidence: 99%

“…Alopecia neoplastica is usually a presentation of metastasis from breast cancer, and any other primary site is extremely rare. Kohno et al 3 reported a case of alopecia neoplastica due to metastasis from gastric carcinoma, and Yuen et al 4 reported a case in which the primary tumour was a placental trophoblastic tumour.…”

Section: Discussionmentioning

confidence: 99%

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Alopecia neoplastica in a patient with gastric carcinoma

1999

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A well-recognized but rare presentation of scalp metastasis is alopecia neoplastica, which occurs as a single or multiple areas of cicatricial alopecia. Alopecia neoplastica is usually a presentation of metastasis from breast cancer, and other primary sites are extremely rare. We report a 36-year-old woman with alopecia neoplastica due to metastasis from gastric carcinoma. She also had pelvic metastases. An asymptomatic erythematous alopecic plaque had developed 10 months before presentation and biopsy was consistent with scalp metastasis. Total abdominal hysterectomy and salphingo-oophorectomy was performed and chemotherapy was proposed.

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“…8,23 Similar to the widely disseminated metastases that can be seen in choriocarcinoma, PSTT can also spread to the vagina, ovary, liver, bowel, kidneys, pancreas, brain, skin, and pelvic and para-aortic lymph nodes. 15,[24][25][26][27] Serum levels of β-hCG are typically in the thousands of IU/L, which is much lower than that of choriocarcinoma. 23 Given both its rarity and wide variation of presentation, it is easy to understand why PSTT may be incorrectly diagnosed in nearly a third of patients.…”

Section: Clinical Presentationmentioning

confidence: 99%

A Review of Current Management of Placental Site Trophoblastic Tumor and Epithelioid Trophoblastic Tumor

Burkett¹,

Soper

2022

Obstetrical &Amp; Gynecological Survey

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Importance: Placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT) are rare forms of gestational trophoblastic neoplasia (GTN). These tumors differ from choriocarcinoma as they are monophasic, have slower growth rates, have lower β-hCG concentrations, and are more chemoresistant. Placental site trophoblastic tumor and ETT can be misdiagnosed, leading to inappropriate management.Objective: The aim of this study was to review the pathogenesis, presentation, pathologic findings, and treatment for PSTT and ETT.Evidence Acquisition: A comprehensive literature review was performed identifying relevant research and review articles. Relevant textbook chapters and guidelines were also reviewed.Results: Placental site trophoblastic tumor and ETT can present months to years after any antecedent pregnancy event with abnormal uterine bleeding and an elevated β-hCG. Tumors are typically confined to the uterus and secrete lower levels of β-hCG compared with other GTNs. The International Federation of Gynecology and Obstetrics prognostic scoring system does not correlate well with prognosis. These lesions can be misdiagnosed as smooth muscle tumors, metastatic melanoma, and cervical squamous cell carcinoma. However, they can be distinguished by their unique histologic and immunophenotypic features.Conclusions: Surgery is the mainstay of treatment for early-stage PSTT and ETT. For patients with advanced disease or for those with poor prognostic indicators, such as an antecedent pregnancy interval of greater than 48 months, a multimodal treatment paradigm of surgery and chemotherapy using a high-risk GTN platinumetoposide containing regimen is recommended.Relevance: Placental site trophoblastic tumor and ETT should be considered in the differential diagnosis in a reproductive age patient presenting with abnormal uterine bleeding and an elevated β-hCG after any antecedent pregnancy event.Target Audience: Obstetricians and gynecologists, family physicians Learning Objectives: After participating in this activity, the reader should be better able to identify the presentation and diagnosis of PSTT and ETT; explain how PSTT and ETT differ from the more common forms of GTN; and describe how surgical resection is the primary treatment modality for PSTT and ETT.

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Scalp Metastases Mimicking Alopecia Areata

Cited by 20 publications

References 36 publications

Desmoplastic melanoma presenting as primary alopecia neoplastica: a report of two cases

Desmoplastic melanoma presenting as primary alopecia neoplastica: a report of two cases

Alopecia neoplastica in a patient with gastric carcinoma

A Review of Current Management of Placental Site Trophoblastic Tumor and Epithelioid Trophoblastic Tumor

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