Table 2.

Clinical presentation of reported cases of alopecia secondary to primary scalp malignancy

Case No.	Gender	Dx age	Lesions,	Lesion duration	Scalp site	Size	Clinical features	Pathology	Primary AN malignant neoplasm	Incorrect tx prior to biopsy?	Ref
1	F	83	Multiple	6 months	Bilateral parietal	Unspecified	Areas of localized scarring, purpuric violaceous patches and an indurated angiomatous mass at right parieto-occipital scalp	Moderately differentiated angiosarcoma (stage 2 or 3)	Angiosarcoma	n/a	[17]
2	F	77	Multiple/diffuse	4 months	Frontal, temporoparietal, vertex	Large, unspecified	Erythematous skin with destroyed follicular orifices and scattered, adherent, serous crust	Diffuse dermal involvement with neoplastic tissue; endothelial cells obliterating adnexal structures and forming irregular vascular channels lined by abnormal cells	Angiosarcoma	Yes − oral prednisone, “topical medication”	[18]
3	F	24	1	Several months	Left temporoparietal scalp	3×2 cm	1.5-cm firm nodule within a 3×2-cm ill-demarcated violaceous patch	Heterogeneous components characteristic of hemangioendothelioma	Hemangioendothelioma	n/a	[23]
4	F	50	1	“Years”	Unspecified scalp	11×7 cm	Smooth, hairless, erythematous area with several 3- to 5-mm deep palpable nodules	Well-differentiated syringomatous carcinoma with aggregations of neoplastic cells extending deep into the reticular dermis; neoplastic cells showing moderate nuclear atypia	Syringomatous carcinoma	Yes − multiple for presumed alopecia areata	[26]
5	F	57	1	Unknown	Right parietal	5×3 cm	Poorly circumscribed, erythematous plaque, with patchy alopecia	Epidermal pagetoid infiltration by atypical single and nested cells with amphophilic cytoplasm and nuclear hyperchromasia, extending along adnexa and the hair matrix. No dermal invasion	Ectopic EMPD	n/a	[6]
6	F	73	1	5 months	Unspecified scalp	20 mm	Solitary nodule with surrounding alopecia	Cohesive nests and single enlarged cells with round to oval nuclei and prominent nucleoli within epidermis; focal mucin vacuoles confirmed with PAS-D staining; nodular BCC confirmed elsewhere in excision. No dermal invasion	Ectopic EMPD with concurrent nodular BCC	n/a	[37]
7	M	86	1	10 years	Right parietal	8.5×6 cm	Erythematous plaque with alopecia and small portion of ulceration	Epidermal pagetoid infiltration by atypical round, single, and nested cells with eosinophilic cytoplasm and nuclear hyperchromasia. No dermal invasion	Ectopic EMPD	n/a	[38]
8	M	50	1	5 months	Left frontal	“Several cm”	Mildly erythematous plaque	Desmoplastic malignant neurotropic melanoma, 2.1-mm thickness, Clark level 5 with probably perineural involvement, S100+	Primary desmoplastic melanoma	n/a	[2]
9	F	66	1	“Few months”	Superior parietal	2 cm	2-cm, firm, white, hairless tender plaque with indistinct borders	Combined desmoplastic and conventional melanoma, 8.5-mm Breslow, S100+, Clark level 5, focal perineural invasion	Primary desmoplastic melanoma	Yes − topical medications for AA versus LPP	[65]
10	F	59	1	4–6 months	Left vertex	1 cm	Pink, firm, hairless plaque	Desmoplastic melanoma, S100+	Primary desmoplastic melanoma	n/a	[65]
11	F	73	1	Unknown	Vertex	1–2 cm	Asymptomatic pink plaque with surrounding 2- to 6-mm scattering pink scaly papules	Severely atypical intraepidermal lentiginous and nested melanocytic proliferation with confluent growth and pagetoid spread, highlighted by a Melan-A stain. No dermal invasion	Amelanotic melanoma	n/a	Our case

AN, alopecia neoplastica; EMPD, extramammary Paget's disease; BCC, basal cell carcinoma.