Dr Rajiv Jha MS M Ch Neurosurgery Resident National Neurosurgical Referral Center National Academy Of Medical Sciences Bir Hospital Lump Under Scalp - Dr. Rajiv Jha

1. Lump Under Scalp
Dr Rajiv Jha MS
M Ch Neurosurgery Resident
National Neurosurgical Referral Center
National Academy Of Medical Sciences
Bir Hospital

2. Patient Profile
Sharma NR
65 years/ Male
Kathmandu

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

4. 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

5. Neurology
 HMF – Intact
 Cranial Nerves with Fundi – Normal
 Neurology – WNL
 Meningism / Cerebellar signs – Absent
Systemic Examination
 Chest
 CVS

6. Provisional Diagnosis
 Cellulitis
 Posttraumatic Cephalhaematoma

7. Investigations
 Haemogram
 Biochemistry
 Viral markers
 Skull X- ray
 CXR
 CT Scan brain
 MRI brain

8. CT Scan brain

9. MRI brain

10. Incisional Biopsy

15. HPE

16. 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

17. 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.

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