SCALP cutaneous metastases from breast carcinoma may present with varied clinical patterns, and new research highlights distinct dermoscopic features that could aid earlier recognition. In a multicenter analysis of 15 patients, alopecia neoplastica emerged as the most frequent phenotype, occurring in more than half of cases. This manifestation, often underestimated in practice, was characterized by a heterogeneous and complex dermoscopic profile compared with nodular or plaque presentations.
The study reported a median age at diagnosis of 64 years. Patients who developed alopecia neoplastica experienced a longer interval between their primary breast tumor and the onset of scalp metastases, with a median of 73.5 months compared with 59.5 months for nodular or plaque forms. Although this difference did not reach statistical significance, it suggests a possible biological divergence in disease progression.
Dermoscopic assessment provided important discriminatory findings. Linear-irregular vessels and polymorphic vascular structures were significantly more common in the alopecia neoplastica group, as were features such as pili torti, follicular hyperkeratosis, and follicular plugging. These findings collectively defined a broader and more heterogeneous dermoscopic profile in alopecic lesions, while nodular and plaque lesions demonstrated a more uniform presentation.
The investigators concluded that alopecia neoplastica not only predominates among scalp metastases from breast carcinoma but also exhibits a distinct set of dermoscopic hallmarks. This complexity could reflect intrinsic biological differences between alopecic and nodular forms. The authors emphasize the need for larger, prospective studies to validate these findings and to integrate dermoscopic evaluation into diagnostic pathways for patients at risk of scalp metastases.
Reference: Sechi A et al. Clinical and Dermoscopic Characterization of Scalp Cutaneous Metastases From Breast Carcinoma: A Multicenter Study of the EADV Task Force on Hair Diseases. Int J Dermatol. 2025. doi: 10.1111/ijd.70059
