Breast Cancer-Related Neoplastic Alopecia: A Case Report and Review of the Literature

Abstract

Neoplastic alopecia (NA) is defined as an organized hair loss in single or multiple areas of the scalp caused by a primary tumor that has metastasized to the skin of the scalp. Due to its localization and clinical appearance, NA should be placed in differential diagnosis with alopecia areata or other entities. To date, pathognomonic dermoscopic criteria of NA have not yet been described: the absence of classical criteria of other scalp diseases in addition to a major neovascularization with on-focus arborizing vessels and erosions or ulcerations may help the clinician to suspect a diagnosis of secondary alopecia. Dermatologists should pay more attention to these rare forms of secondarism because in exceptional cases, a simple alopecia of the scalp can hide a new, relapsing or metastatic neoplasia.

Keywords: Alopecia; Dermatopathology; Dermoscopy; Skin cancer.

Fig. 1

a Clinical appearance of NA due to breast cancer with a 10 × 8-mm plaque of the parieto-occipital region with neovascularization. b Dermoscopy features of NA showing giant on-focus arborizing vessels in a pink-whitish background with an orangish well-defined lesion of about 5 mm in diameter. NA, neoplastic alopecia.

Fig. 2

a Single file carcinomatosis elements, ×20. b Evidence of pagetisation phenomena, the expression of CK7 is oriented towards the epithelial origin of the neoplasm, ×20.

Fig. 3

a Breast ultrasound showing a 15-mm hypoechogenic solid lesion of the super-external quadrant compatible with the secondary lesion of previous breast cancer. b Diagnostic mammography of the right breast. A well-defined contrast area, with a diameter of about 15 mm of the super-exterior quadrant and in the external para-areolar, 8.5 mm.