BACKGROUND/AIMS

Although subcutaneous lesions of the scalp are more common than those of the skull, few studies in literature have assessed the frequency of scalp and skull diseases. The goal of this study was to establish the frequency and main histopathological findings of these lesions. Our study is one of the largest series and shows that the incidence of surgically excised scalp masses includes an array of diseases.

MATERIAL and METHODS

We reviewed 265 extracranial masses from 173 patients. The mean age of the patients, gender distribution, localization and characteristics of lesions, histopathological type and radiological features were analyzed.

RESULTS

One-hundred (57.8%) patients were males and 73 (42.2%) were females. The mean age was 42.98 (range, 5-87). In total, 261 were within the scalp, 1 involved the scalp and skull and 3 were within the limits of the skull. Six lesions exhibited malignant features. There were 101 trichilemmal cysts; 74 epidermal cysts; 38 intradermal nevus; 8 verruca vulgaris; 5 squamous cell papilloma; 4 seborrheic keratosis; 4 capillary hemangioma; 3 compound nevus; 3 proliferating trichilemmal cyst; 2 blue nevus; 2 neurofibroma; 2 basal cell carcinoma; 2 langerhans cell histiocytosis; 2 fibrolipoma; 2 folliculitis decalvans and 1 case each of lipoma, dermoid cyst, pilomatricoma, cylindroma, nodular hidradenoma, apocrine cystadenoma, arteriovenous malformation, fibroepithelial polyp, folliculitis, malignant proliferating trichilemmal tumor, follicular carcinoma metastasis, fibrous dysplasia and inflamed fistula tract. No recurrence was seen except for 1 lesion.

CONCLUSION

Although the involvement of the skull is rare, scalp masses present a wide histopathologic spectrum of that arise in all ages. Overall, a majority of these lesions are benign and the presence of a malignant tumor or metastatic tumor presenting as a skull mass is less common. Lesions having intracranial/extracranial extensions may be treated with complete resection followed by skull reconstruction and a close follow-up is necessary.

Keywords: Scalp, skull, calvarium, excision, biopsy, histopathology