Massive Secondary Cutaneous Meningioma with Extension to the Face

Cutaneous meningioma is a very uncommon pathologic entity that can be divided into primary and secondary types. Secondary cutaneous meningioma arises from an intracranial meningioma through metastasis, seeding during surgery, or direct bone invasion. There are limited published case reports correlating the development of cutaneous meningioma to high-grade convexity meningioma.

A 63-year-old man underwent total resection of a right frontal convexity meningioma, World Health Organization Grade I in 2001. He presented in 2016 with a small frontal cutaneous mass over the craniotomy site. Computed tomography showed extracranial and intracranial components of the meningioma. The patient declined surgical intervention and lost to follow. One and half years later, he underwent resection of the growing ulcerating cutaneous component in an outside hospital. The pathological diagnosis was Grade 3 meningioma. Six months later, he presented to us with a massive cutaneous meningioma and large intracranial component. Surgical resection and multidisciplinary management were planned. The patient was very hesitant to have surgery but settled for receiving radiation. Seven months after radiation, he presented with a decreased level of consciousness and skin necrosis with maggot infestation. His code status was changed to "do not attempt resuscitation," and he died 3 days later in December 2019.

Large intracranial meningiomas with massive transosseous extension to the scalp pose a significant challenge to the treating team. Proper planning and a multidisciplinary approach are essential. However, prognosis remains generally poor.