Fine-needle aspiration of scalp lesions

A variety of inflammatory and neoplastic scalp lesions are encountered in s urgical pathology. However, the literature on fine-needle aspirations (FNAs ) of the scalp is exceedingly rare. We report on a series of 70 FNAs involv ing cutaneous and subcutaneous lesions on the scalp. A total of 70 fine-nee dle aspirations of cutaneous and subcutaneous scalp lesions was reviewed to identify patterns of metastasis to the scalp and to demonstrate the effect iveness of FNA in diagnosing these lesions. There were 42 male and 28 femal e patients, ranging in age from 29-91 yr (mean, similar to 61 yr). Sixty-on e patients had a previous history of malignancy. Of these aspirates, 59 wer e neoplastic, consistent with the patient's known primary. One case was an abscess, and the remaining case was unsatisfactory for cytologic evaluation . Follow-up biopsy revealed granulomatous inflammation. The most common pri mary tumor to metastasize to the scalp was lung carcinoma, which was seen i n 18 cases, followed by hematopoietic malignancies in 14 cases. Melanoma wa s identified in 6 cases, head and neck tumors in 5 cases, renal malignancie s in 4 cases, gastrointestinal tumors in 3 cases, sarcoma in 3 cases, breas t and prostate malignancy in 2 cases each, and an olfactory neuroblastoma a nd meningioma in 1 case each. The remaining 9 aspirates were from patients who did not have a previous history of malignancy. These included 6 benign aspirates consisting of 3 epidermal inclusion cysts, 2 lipomas, and 1 neuro fibroma. two aspirates were malignant and included 1 primary squamous-cell carcinoma and 1 metastic adenocarcinoma of unknown origin. the remaining ca se was unsatisfactory for cytologic evaluation. Follow-up biopsy of this le sion showed noncaseating granulomas. Of the aspirates from patients with a previous history of malignancy, 97% were neoplastic Lung carcinoma and hematopoietic malignancies were the most common neoplasm s that metastasized to the scalp. Since the scalp is a common site for meta stasis, awareness of this fact is useful to both oncologists and dermatolog ists. It must be understood that FNA can provide a rapid and accurate diagn osis in the evaluation of scalp masses. (C) 2000 Wiley-Liss, Inc.