Primary cutaneous neuroendocrine tumour of the scalp with metastasis

We report the case of a female patient in her 60s diagnosed with a Grade 2 cutaneous neuroendocrine tumour. The patient was referred after dermatological resection of a mass on her right frontal scalp. Pathologic examination at an outside centre initially misclassified the tumour as hidradenocarcinoma. Physical examination revealed a 3.5 cm ulcerative plaque at the scalp vertex. MRI revealed a prominent right pre-auricular lymph node and a 3.5 cm heterogeneous scalp mass suspicious for residual tumour. Both areas were fluorodeoxyglucose avid on positron emission tomography. On surgical re-resection of the tumour and nodal basins, pathologic examination yielded the diagnosis of cutaneous neuroendocrine tumour metastatic to intra-parotid lymph nodes. The patient completed a course of radiotherapy but, at seventeen months, was found to have recurrent local and metastatic pulmonary disease. The patient subsequently underwent surgical resection of the residual tumour as well as radiotherapy and palliative chemotherapy. The patient continues to be closely followed.