Aggressive sebaceous carcinoma of the scalp: a case report and literature review.

Introduction: Sebaceous carcinoma (SC) is an uncommon, potentially aggressive neoplasm of the sebaceous glands. It is most commonly noticed in periorbital region whereas extraorbital lesions are extremely rare. Case Presentation: A 52-year-old male patient presented with irregular, exophytic lesion on the scalp with posterior cervical lymphadenopathy. The reports of incisional and excisional biopsy suggested sebaceous carcinoma and fine needle aspiration cytology (FNAC) of lymph node was positive for malignancy. Two stages surgery by multidisciplinary team was performed followed by adjuvant radiotherapy for 8 weeks. On follow-up the patients condition was improved and is strictly being monitored for local recurrence. Clinical Discussion: SC is a rare, slow growing tumor which occasionally shows aggressive behaviors. Primary site of occurrence of SC are those with abundant sebaceous glands like eyelids, face and scalp. It presents as painless, gradually enlarging, firm subcutaneous nodule or pedunculated lesions with tendency to ulcerate and cause spontaneous bleeding. It is commonly misdiagnosed as other common inflammatory dermatological conditions or tumors. For local disease, Mohs micrographic surgery or wide local excision of the lesion is preferred, whereas radiation and systemic chemotherapy also has a place in its treatment. Conclusion: Varied presentation of sebaceous carcinoma causes delayed diagnosis or misdiagnosis which increases morbidity and mortality. Histopathological examination of any suspicious lesion is a must before or during surgery to prevent such occurrences.