Dermatology and Cosmetology, IRCCS San Raffaele Hospital, Milan, Italy.
Department of Dermatology, La Sapienza University of Rome, Rome, Italy.
J Eur Acad Dermatol Venereol. 2019 Jun;33(6):1020-1028. doi: 10.1111/jdv.15498. Epub 2019 Mar 12.
Alopecia neoplastica (AN) from visceral tumours is a rare form of cutaneous metastasis in which internal malignancies spread to the scalp. The diagnosis of AN may be very challenging, especially when its onset precedes the diagnosis of the primary tumour. We aimed to improve the knowledge on AN, highlighting that in case of scarring localized alopecia, a differential diagnosis with metastasis should always be considered. We performed a systematic review to describe the main demographic and clinical features associated with AN from visceral malignancies; a survival analysis was also performed. In 118 reports, accounting for 123 patients, we found that women were more affected by AN than men (53.7% vs. 46.3%). The most frequent site of the primary tumour was the gastrointestinal tract (24.4%), followed by breast (17.9%), kidney (8.1%), lung (7.3%), thyroid (7.3%), uterus (6.5%), central nervous system (6.5%), liver (3.3%) and other anatomic areas for 18.7% of cases. Furthermore, in more than half of the cases (66.1%), AN lesions were single and were mainly diagnosed after the primary visceral tumour (71.5%). Finally, survival analysis highlighted a lower progression-free survival in men; while, no significant differences in overall survival were reported among genders. In conclusion, metastatic skin disease should always be taken into consideration when dealing with patients with localized scarring alopecia.
内脏肿瘤所致脱发（AN）是一种罕见的皮肤转移形式，其中内部恶性肿瘤扩散至头皮。AN 的诊断可能极具挑战性，特别是在原发性肿瘤诊断之前其就已出现时。我们旨在提高对 AN 的认识，强调在出现瘢痕性局部脱发时，应始终考虑与转移的鉴别诊断。我们进行了系统回顾，以描述与内脏恶性肿瘤相关的 AN 的主要人口统计学和临床特征；还进行了生存分析。在 118 份报告中，涉及 123 名患者，我们发现女性比男性更容易受到 AN 的影响（53.7%比 46.3%）。原发性肿瘤最常见的部位是胃肠道（24.4%），其次是乳房（17.9%）、肾脏（8.1%）、肺部（7.3%）、甲状腺（7.3%）、子宫（6.5%）、中枢神经系统（6.5%）、肝脏（3.3%）和其他解剖区域占 18.7%的病例。此外，超过一半的病例（66.1%）中，AN 病变为单发，主要在原发性内脏肿瘤后诊断（71.5%）。最后，生存分析显示男性无进展生存期较低；而在总体生存方面，性别之间没有显著差异。总之，在处理局部瘢痕性脱发的患者时，应始终考虑到转移性皮肤疾病。
