Introduction: Squamous cell carcinoma is the second most common form of aggressive skin cancer and is due to exposure of ultraviolet radiation (UV-B), immunosuppression, inflammation (from trauma or burns), and chemicals. It is most common in older, white populations in Europe, United States, and Australia. Primary lesions occur most commonly on the face, neck, ears, hands and arms but metastases are uncommon. In contrast, squamous cell carcinoma is uncommon in younger and darker-skin individuals, especially those living in Africa. Case presentation: In this case, a 37-year-old native African man, without any significant past medical history, presented to the hospital with a well circumscribed, ulcerative lesion of the left parietal-temporal scalp which had not healed for four years. Head CT evaluation excluded distal metastasis. Wide superficial local excision with ipsilateral occipital lymph node biopsy revealed an infiltrative well-differentiated squamous cell carcinoma with metastasis to a left occipital lymph node. Pathological examination of the deep marginal excision with ipsilateral posterior cervical lymph node biopsy did not reveal any residual carcinoma but did show benign follicular hyperplasia in the cervical lymph node. He underwent a split thickness skin graft of the scalp wound. Systemic chemotherapy will follow. Discussion: Although the incidence of squamous cell carcinoma is lower in younger, African people, it is important to consider the diagnosis for a suspicious lesion. It is essential to utilize both surgical and histological examinations to establish a diagnosis. However, the correct management of squamous cell carcinoma is debatable, especially on the scalp.
Nickul Shah, Purcell R, Cooper A, Roman D
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