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Giant cutaneous squamous cell carcinoma of the scalp arising in the setting of folliculitis decalvans
  1. Liang Ding1,
  2. Jason C DeGiovanni2,
  3. Paul Bogner3 and
  4. Yousef Soofi1
  1. 1Department of Pathology, State University of New York at Buffalo, Buffalo, New York, USA
  2. 2Department of Otolaryngology – Head and Neck Surgery, State University of New York at Buffalo, Buffalo, New York, USA
  3. 3Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
  1. Correspondence to Dr Liang Ding; liangdin{at}


Squamous cell carcinoma (SCC) is uncommon in African Americans (AAs), with an incidence of approximately 0.003%. However, it is the most common skin cancer in that patient population. In AAs, SCC typically arises in sun-protected areas and mainly affects patients older than 50 years. We report a case of giant SCC in an AA man in his 40s with long-standing folliculitis decalvans on the scalp. Three previous skin biopsies were inconclusive. A wide excision was performed and the defect was reconstructed with an anterolateral thigh free flap. Histological analysis of the resected specimen revealed a well-moderately differentiated keratinising SCC with clear cell changes, severe mixed inflammation, folliculitis and dermal scar. He was discharged 2 weeks later and has been followed up closely. Four months later, the patient presents with metastatic SCC to an occipital lymph node.

  • pathology
  • head and neck surgery
  • surgical oncology
  • head and neck cancer
  • skin cancer

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  • Contributors YS was the pathologist who received the resection specimen, made the final diagnosis and directed this case report. LD was the pathology resident who participated in the specimen examination and diagnosis, drafted the manuscript and designed the figures. JD was the otolaryngology resident who participated in the surgery, patient follow-ups, manuscript modification and obtaining patient consent. PB was involved in the clinical management of the patient in the past. He reviewed the patient’s biopsy slides and edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.