Scalp ulcers - differential diagnoses that should be sought!

Background: Ulceration of the scalp is an uncommon clinical presentation, and it may be caused by myriads of cutaneous etiologies such as infections, inflammatory disorders, and malignancies. We sought to reveal the underlying etiology of scalp ulcers referred to our tertiary wound healing clinic; we would also like to propose a classification for scalp ulcerations.

Methods: A retrospective study was conducted in an academic tertiary wound healing clinic between January 2015 and June 2018. The study was approved by the Women's College Hospital Institutional Research Ethics Board. We have also conducted a review of the literature to recognize the major causes of scalp ulceration reported in the literature.

Results: We have identified a total number of 15 patients with scalp ulceration. Twelve patients with atypical scalp ulcers underwent a skin biopsy. A malignancy rate of 73% (11/15) was diagnosed histologically. The review of the literature showed 237 articles. After screening the title and the abstracts, we have selected 41 case reports for the full text review.

Conclusion: Scalp ulcers are uncommon but important. Our sample study indicates the high frequency of malignant etiologies presenting as scalp ulcers. These results emphasize not only the need for clinicians to be on the watch for the possibility of this option but rather highlights the need for early biopsy to prevent further complications. We hope that our paper helps to shed some light on this topic and guide clinicians on how to approach scalp ulceration.