Carcinoma espinocelular em couro cabeludo inicialmente diagnosticado como queratoacantoma / Squamous cell carcinoma of the scalp initially diagnosed as keratoacanthoma

O queratoacantoma pode com muita facilidade ser confundido com carcinoma espinocelular, tanto clínica quanto histopatologicamente. Só o queratoacantoma, entretanto, pode regredir de maneira espontânea. Relata-se caso de paciente com lesão exofídica, ulcerada e infiltrada em couro cabeludo previamente diagnosticada como queratoacantoma. O exame histopatológico confirmou carcinoma espinocelular, e a tomografia de crânio evidenciou invasão da calota craniana. Procedeu-se à excisão cirúrgica com margens amplas e confecção de retalho de rotação, seguida de tratamento adjuvante com quimioterapia e radioterapia. Há muitos relatos na literatura de carcinomas espinocelulares erroneamente diagnosticados como queratoacantomas demonstrando a dificuldade nessa diferenciação. Enquanto não se estabelecem métodos eficazes para distinguir as duas entidades, o tratamento de escolha deve ser a excisão cirúrgica.

Keratoacanthoma may be easily mistaken with squamous cell carcinoma, both clinically as well as histopathologically. However, only keratoacanthoma can regress spontaneously.We report a case of a patient with a exophytic, ulceraded, infiltrated lesion in their scalp that was initially diagnosed as a keratoacanthoma. The histopathologic examination confirmed the presence of squamous cell carcinoma, and the tomography of the skull showed that the cancer had spread within the cranium. A surgical excision with wide margins and rotation flap was conducted, followed by adjuvant chemotherapy and radiotherapy treatments.There are a great number of accounts of squamous cell carcinoma erroneously diagnosed as keratoacanthomas in the specialist literature, illustrating the difficulty in differentiating between them.While there is no established effective method to distinguish between the two conditions, surgical excision should be the treatment of choice.

Caso para diagnóstico / Case for diagnosis

Queratose folicular espinulosa decalvante é uma genodermatose rara, ligada ao X, caracterizada por hiperqueratose folicular, fotofobia, alopécia cicatricial do couro cabeludo e supercílios. Descreve-se o caso de paciente do sexo feminino, de 25 anos, com quadro clínico e evolução típicos desta síndrome.

Keratosis follicularis spinulosa decalvans is a rare X-linked genodermatosis, characterized by follicular hyperkeratosis, photophobia, scarring alopecia of the scalp and eyebrows. A case of a 25 yearold female with typical clinical picture and progression of this syndrome is described.

[Case for diagnosis]. / Caso para diagnóstico.

Keratosis follicularis spinulosa decalvans is a rare X-linked genodermatosis, characterized by follicular hyperkeratosis, photophobia, scarring alopecia of the scalp and eyebrows. A case of a 25 year old female with typical clinical picture and progression of this syndrome is described.