Lump Under Scalp

Dr Rajiv Jha MSM Ch Neurosurgery Resident

National Neurosurgical Referral CenterNational Academy Of Medical Sciences

Bir Hospital

Patient Profile

Sharma NR

65 years/ Male

Kathmandu

Complaints of

Headache – 2months Scalp swelling – 2 months No LOC/ Vomiting / Seizure / Fever H/O Trauma – 2 months back DM (-) Htn (-) Non Alcoholic / Smoker

L/E

Swelling in the frontal area without obvious demarcation/ boarder. Skin over the swelling was normal

Hard to firm consistency, mild to moderate tenderness, smooth surface, ill defined margin, non pulsatile /Non fluctuating. Marginal elevation of local temperature

Cough impulse – absent Cervical LN’s – Not palpable

Neurology

HMF – Intact Cranial Nerves with Fundi – Normal Neurology – WNL Meningism / Cerebellar signs – Absent

Systemic Examination Chest CVS

Provisional Diagnosis

Cellulitis Posttraumatic Cephalhaematoma

Investigations

Haemogram Biochemistry Viral markers Skull X- ray CXR CT Scan brain MRI brain

CT Scan brain

MRI brain

Incisional Biopsy

HPE

Discussion Primary skin cancers of the scalp are not uncommon, representing approximately 2% of all

skin cancers It is commonly recognized that skin cancer, regardless of location, can microscopically

extend a significant distance beyond what is clinically apparent On the scalp, however, a significant proportion of tumors exhibit this tendency, in large part

due to the anatomy of the scalp. The subgaleal plane offers little resistance to tumor spread and tumors, once they penetrate periosteum, they can spread laterally for great distances

Risk factors for developing SCC of the scalp are well known and include chronic actinic damage, prior treatment with ionizing radiation, immunosuppression, chronic scarring, and certain genodermatoses.

Despite the common name, these are unique cancers with large differences in manifestation and prognosis

Males are affected with SCC at a ratio of 2:1 in comparison to females

Discussion cont.. Features that are typically thought to be associated with recurrence of SCC

include the size of the tumor, prior treatment, immunosuppression, and histologic features such as perineural invasion, the presence of acantholysis, the lack of differentiation, and the growth pattern of the tumor.

There are data indicating that squamous cells of the scalp may be more dangerous than generally thought.

If treated early and properly, the cure rate for SCC is greater than 90 percent. SCC metastases are seen in between 1 and 5 percent of cases and are associated with a poor prognosis.

Patients treated for SCC are at increased risk for the development of all types of nonmelanoma skin cancer; regular skin examinations are indicated.

Karjalainen and coworkers4 reviewed the Finish cancer registry for the years 1967 through 1981. They noted that in men, SCCs of the scalp and neck were associated with the poorest long-term survival rate (80.2%). Interestingly in the series of patients with in-transit metastases from primary SCCs of the skin, Carucci and colleagues5 found the scalp to be one of the common locations for SCCs developing in-transit metastases.

conclusion

Primary subgaleal SCC is although unreported, , should be considered in D/D of scalp lump!