Unusually Aggressive Squamous Cell Carcinoma of the Scalp

Objective To report a series of unusually aggressive squamous cell carcinoma of the scalp and to discuss the current strategies for the diagnosis and management of this disease state. Method Patients with well‐differentiated scalp squamous cell carcinoma, presenting with locally invasive disease and aggressive features were identified. We performed a chart review for each patient in this series. The literature is reviewed as it pertains to prior reports and diagnostic strategies for identifying these uncharacteristically aggressive lesions. Results We present a series of 5 patients with well‐differentiated squamous cell carcinoma of the scalp that behaved in an unusually aggressive pattern for its level of differentiation. This included local invasion of calvarium, recurrence, and satellite lesions. We did not identify in this case series any correlation between the degree of differentiation and the aggressiveness of the cancer. We did not elucidate any risk factors or histologic identifiers to explain this phenomenon, which has not been previously described in the head and neck literature. Conclusion Aggressive squamous cell carcinomas of the scalp may progress to the point of metastasis and death despite appropriate initial therapy. The clinician should be aware that these aggressive features, typically associated with poorly differentiated squamous cell carcinomas, may exist with any level of differentiation when found on the scalp.