Scalp lesions. A review of histopathologic and fine-needle aspiration biopsy findings

We reviewed surgical and cytological scalp specimens at Loyola University Medical Center over an 8-year period. The incidence and types of pathologic entities that appeared in the scalp were tabulated, and the roles of surgery and fine-needle aspiration biopsy (FNAB) were investigated. There were 352 patients with scalp tissue biopsies. There were 41 primary malignancies, and 3 metastatic carcinomas. FNAB specimens were obtained from 36 other patients. Of these, 29 specimens showed malignant cytology. All of these patients had a previous diagnosis of malignancy. Scalp tissue biopsy specimens were far more likely to have a benign diagnosis than were FNAB specimens (P < 0.00001). This difference is probably due to the patients' histories and referring physicians. Healthy patients with a scalp lesion will generally present to a dermatologist, who will obtain a tissue specimen. In contrast, a patient with a history of malignancy with a scalp lesion will follow up with an oncologist, who may prefer FNAB to surgical procedures in order to diagnose such a lesion rapidly. The scalp is a common repository for metastatic tumors, most likely due to its rich vascularity. Awareness of this fact can be useful to dermatologists or oncologists in selecting the better diagnostic procedure for a patient.