Alopecia neoplastica simulating alopecia areata and antedating the detection of primary breast carcinoma

A woman with no previous history of breast carcinoma presented with focal hair loss, which was presumptively diagnosed as alopecia areata. After treatment failures, a scalp biopsy was performed, which subsequently led to the diagnosis of breast carcinoma. This case illustrates the subtle course which breast cancer can take and the insidious manner in which it may present. It alerts clinicians and pathologists to the possibility of secondary causes, including malignancy, in the differential diagnosis of alopecia refractory to usual treatments.