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Scalp metastasis from glioblastoma
  1. R S Allan
  1. Dr R Allan, Department of Neurosurgery, Westmead Hospital, Hawkesbury Road, Westmead NSW 2145, Australia;

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    A 60 year old male who had previously undergone a craniotomy and debulking of a glioblastoma multiforme re-presented with several subcutaneous nodules in his scalp. He had undergone a course of radiotherapy, and it had been one year since his original surgery. Over the two months prior to his admission he had undergone a significant decline in his level of functioning, and was now dependent for most of his activities of daily living.

    Computed tomography (CT) scanning showed that the scalp lesions were vividly enhancing, and that there was diffuse intracranial recurrence, with hemispheric oedema. Owing to his poor performance status, he was treated with high dose corticosteroids, and a palliative approach was undertaken, without further surgery. The patient died two months later.

    Extracranial metastasis from primary cerebral tumours is a rare occurrence. It has been reported previously with metastases to lymph nodes and via ventriculoperitoneal shunts to the abdomen,1,2 and also along stereotactic biopsy tracts.3,4 Metastasis to the cranial bones prior to any surgical intervention has also been documented.5 Implantation of tumour cells at the time of surgery is well described in the literature for a variety of forms of surgery,6 and there have also been occasional case reports of such metastases after neurosurgery.7,8 The current case serves to highlight the potential risk of such implantation and metastasis. Strategies to reduce the incidence of these metastases would include watertight approximation of the dura, replacement of the bone flap, and changing of surgical instruments once the intradural component of the surgery is completed.

    Figure 1

    Post contast CT scan showing ring enhancing subcutaneous metastasis and hemispheric oedema.

    Figure 2

    Post contrast CT showing two further nodules of subcutaneous tumour.

    Figure 3

    Posterior clinical photograph showing tumour deposits.

    Figure 4

    Anterior clinical photograph.