Malignant cylindroma of the scalp treated with staged perimeter excision: A case report and literature review

Abstract

Malignant cylindroma is a rare and poorly understood cutaneous malignancy. There is a paucity of literature on these lesions, with only a select number of case reports and limited guidelines on management. We present a case of a 60-year old patient with a malignant cylindroma of the scalp treated surgically with staged perimeter excision and summarize our review of the literature with a focus on management of this potentially aggressive disease.

Keywords: Cylindrocarcinoma; Malignant cylindroma; Perimeter excision; Skin adnexal tumours.

Figure 1

Perimeter excision resection method for malignant cylindroma. (A) Initial patient presentation with scar resulting from two previous excisional biopsies. (B) Pre-operative markings for perimeter biopsies with pathological specimens labelled 1–12 for separate analysis. 2 cm margins marked with wider margins favoured superiorly due to positive margins on previous resection. (C) Post-operative photograph with prolene stitch marking each separate biopsy specimen and remainder of incision closed with gut suture (Patient consent was obtained for inclusion in this case report and for photo-documentation).

Figure 2

Definitive resection of malignant cylindroma. (A) Intra-operative photograph with definitive resection of malignant cylindroma at level of galeal with frozen section control. Bone burred centrally to ensure local control. (B) 3 months post-operative. (Patient consent was obtained for inclusion in this case report and for photo-documentation)

Figure 3

Histological features of malignant cylindroma. (A) Hematoxylin and eosin (H&E) staining of paraffin fixed tissue biopsy specimen viewed at 2× magnification. The tissue section demonstrates cylindroma-like nests infiltrating into the dermis and subcutaneous tissues. (B) Higher 20× magnification of the tissue specimen showing irregular aggregates of malignant cylindroma cells with focal absence of basement membranes and loss of ‘jigsaw’ pattern. (C) 20× magnification highlight cytological atypia. (D) Immunohistochemical staining for Ki-67, Positive stained cells appear brown. (Patient consent was obtained for inclusion in this case report and for photo-documentation)