Invasive cutaneous squamous cell carcinoma associated with actinic keratosis: a case with orbital invasion and meningeal infiltration

Nonmelanoma Skin Cancer with Skull Infiltration and Cranial Involvement

BACKGROUND

Skin cancer is an uncommon cause of skull invasion, dural infiltration and brain parenchyma involvement.

CASE REPORT

We report on a series of three elderly patients who presented with squamous cell carcinoma of the scalp with skull bone and cerebral invasion and discuss the diagnostic and therapeutic challenges.

CONCLUSION

A major factor of delayed diagnosis of this potentially life-threatening skin cancer feature is patients' neglecting.

Imaging findings of head and neck dermatofibrosarcoma protuberans

BACKGROUND AND PURPOSE

Dermatofibrosarcoma protuberans is a rare, locally aggressive sarcoma of the skin in children and adults, usually involving the trunk and extremities and less commonly the head and neck. Despite clinical reports in the literature on the management of dermatofibrosarcoma protuberans, there are limited articles describing its imaging features.

MATERIALS AND METHODS

We retrospectively reviewed the demographics and imaging findings in all 24 patients with pathologically proven dermatofibrosarcoma protuberans of the head and neck seen at a tertiary cancer center between 2001 and 2010.

RESULTS

Twenty-two of the 24 lesions were nodular and well circumscribed; 19 of the 24 were located on the scalp. On imaging, all 24 lesions involved subcutaneous tissues. The lesions ranged in size from 0.6-9.5 cm (mean, 3.7 cm; standard deviation, 2.3 cm). Twelve lesions involved the soft tissues either at or extending directly to the midline. Thirteen lesions were associated with bulging of the skin surface. Fourteen lesions were imaged with CT and 14 with MR imaging. Whereas variable enhancement patterns were noted on CT and MR imaging, dermatofibrosarcoma protuberans was usually T2-hyperintense and demonstrated marked enhancement. None of the lesions was associated with bone invasion, perineural spread, or nodal/distant metastasis.

CONCLUSIONS

Knowledge of the imaging characteristics of dermatofibrosarcoma protuberans may alert neuroradiologists to include dermatofibrosarcoma protuberans in the differential diagnosis of lesions about the head and neck with similar imaging characteristics.

Actinic keratosis: a clinical and epidemiological revision

Actinic keratoses are benign intraepithelial skin neoplasms constituted by atypical proliferation of keratinocytes that may evolve to squamous cell carcinoma. They develop in photoexposed skin areas; they are induced mainly by ultraviolet radiation and are considered cutaneous markers of chronic exposure to sunlight. They develop mainly in adults and older, fair skinned individuals, and are the fourth most common cause of dermatologic consultation in Brazil. Damage to the apoptosis pathway in photoexposed epithelium favors cellular proliferation and the permanence of the lesions. In this revision, the authors assemble the main epidemiological data regarding this disease and suggest that strategies to identify risky phenotypes, early diagnosis, adequate treatment, clinical follow-up, stimulus to skin self examination, photoeducation and photoprotection should be promoted with the aim of avoiding the progression to malignancy and also the prevention and the diagnose of concomitant neoplasms also induced by ultraviolet radiation.

The development of actinic keratosis into invasive squamous cell carcinoma: evidence and evolving classification schemes

Actinic keratosis is an incipient form of cutaneous squamous cell carcinoma. Consequently, actinic keratoses must be treated expeditiously to forestall their downward growth. Several classification schemes have been proposed to better categorize actinic keratoses, and to guide their diagnosis and treatment. Among these approaches is the "keratinocyte intraepithelial neoplasia" (KIN) system developed by Cockerell; Goldberg's concept of the "proliferative actinic keratosis" (PAK), and Berhane's emphasis on the "inflamed actinic keratosis" (IAK). In the future, disparate classification schemes may be unified into a single pragmatic approach which accurately reflects the biological process whereby actinic keratoses devolve into invasive squamous cell carcinoma.

Meningeal Carcinomatosis in Two Cats

Multifocal to diffuse meningeal infiltration by neoplastic epithelial cells was observed in two aged cats with neurological signs and a history of surgical ablation of the auricular pinnae because of the presence of squamous cell carcinoma. In both cats, examination of the external ear canals revealed neoplastic lesions consistent with squamous cell carcinoma, but no changes of the tympanic bullae were noted. In one cat, post-mortem examination revealed marked thickening of the dura mater and infiltration of the arachnoid layer by cytokeratin-positive, neoplastic epithelial cells. In the other cat, no macroscopic brain lesions were noted, but multifocal dissemination of neoplastic epithelial cells to the leptomeninges was observed histologically. Several pathways by which neoplastic cells can reach the meninges have been suggested and haematogenous dissemination was considered most likely in these cats. Squamous cell carcinoma is the most common cutaneous malignant neoplasm in cats and meningeal carcinomatosis can be considered a rare complication.