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Review
. 2024 Jul 30;14(15):1638.
doi: 10.3390/diagnostics14151638.

Diagnosis and Management of Scalp Metastases: A Review

Stephano Cedirian  1   2 , Luca Rapparini  1   2 , Andrea Sechi  3 , Bianca Maria Piraccini  1   2 , Michela Starace  1   2
Affiliations
Review

Diagnosis and Management of Scalp Metastases: A Review

Stephano Cedirian et al. Diagnostics (Basel). .

Abstract

Scalp metastases (SMs) are particularly noteworthy, representing around 4-7% of cutaneous neoplasms in this region of the body, possibly due to its rich blood supply. Diagnosis of SMs involves a systematic approach encompassing oncologic history, clinical examination, dermoscopy, imaging, and histopathological assessment. Clinical presentations of SM can vary, but dermoscopy reveals unique vascular patterns aiding in diagnosis. Imaging, particularly MRI and CT, and histopathological evaluation are mandatory for definitive diagnosis. Treatment strategies vary depending on tumor characteristics and staging, ranging from surgical excision to systemic therapies like chemotherapy or radiotherapy. Multimodal approaches tailored to individual cases yield optimal outcomes. The diagnostic tools available do not always allow SMs to be diagnosed, and often the lack of knowledge on the part of oncologists in suspecting SMs can delay an early diagnosis. This review provides clinicians with a practical guide for the timely diagnosis and management of SM, emphasizing the importance of a multidisciplinary approach and personalized treatment strategies for improved patient outcomes.

Keywords: cancer; dermoscopy; histopathology; imaging; management; oncodermatology; prognosis; scalp metastases; trichoscopy.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Clinical (a,b) and dermoscopic (c,d) image of a SM in a 49-year-old female patient affected by breast cancer. SM presented as multiple, infiltrated, rounded, and edematous alopecic patches, with sharp confluent margins, red in color. Dermoscopy (20×) shows diffuse erythema with a polymorphous vascular pattern, with irregularly shaped dilated, serpentine, and polymorphic vessels. Circle hairs and diffuse vellus hairs in some patches are present.
Figure 2
Figure 2
Full-thickness dermal infiltration by carcinoma of solid-cord structure and intermediate nuclear grade. SM of breast origin. (a) Vertical section (Haematoxylin and Eosin, 5×). (b) Horizontal section (Haematoxylin and Eosin, 3×).
See this image and copyright information in PMC

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