Rare extraocular sebaceous carcinoma of the scalp: A case of cauliflower-like lesion treated with radiotherapy and surgery

Sebaceous carcinoma at the extraocular sites is an extremely rare tumor. This is the case report of sebaceous carcinoma of the scalp in a 35-year-old male presenting with a fungating cauliflower-like mass on the scalp. There is no standardized treatment for such presentation, which is why it is important to highlight such rare cases, for optimizing treatment plans in the future. A 35-year-old male presented with a fungating, disfiguring lesion on the scalp, which started as a small lesion 3-4 years ago. The patient took ayurvedic treatment, followed by four surgical excisions at other facilities, which did not provide relief. Besides mild discomfort and social embarrassment, the patient did not report any symptoms. The past medical, social, and family history of the patient were unremarkable. At the presentation, the patient looked pale and had edema in the left ankle. On examination, multiple mobile subcentimeter lymph nodes were noted in the head and neck region. The lab assessments revealed hemoglobin of 4.2 g/dL. The patient was admitted and transfused with four units of packed red blood cells. CT scan of the brain showed an irregular mass in the parietal, frontal, and occipital region, causing lytic erosion of the high parietal bone and infiltrating the adjacent dura. Histopathological report revealed the lesion to be sebaceous carcinoma. PET-CT scan showed increased fluorodeoxyglucose uptake in the head, neck, and lungs. The case was discussed in a multidisciplinary tumor board, and radiation was planned. Radiotherapy effectively reduced the size of the tumor, making surgical intervention feasible. This case emphasizes the importance of individualized treatment and thorough evaluation with a multidisciplinary approach for appropriate treatment planning.