Scalp Alopecia due to a Clinically Unapparent or Minimally Apparent Neoplasm (SACUMAN): Long Name for An Important Concept

Scalp alopecia due to a clinically unapparent or minimally apparent neoplasm (SACUMAN) is a rare condition. It refers to a type of alopecia neoplastica wherey neoplastic cells invade the are in and around hair follicles and cause hair loss. However, they do so in a manner which is quite subtle and leave the underlying skin looking fairly normal.

I was very interested to read a report recently by Tomasini et al. outlining a cause of basal cell carcinoma mimicking androgenetic alopecia.

Tomasini CF et al. 2024

Authors reported the case of a 74-year-old woman who presented with concerns about a 5-year history of progressive hair loss. The patient had a past medical history of breast cancer. What was so interesting about this case is that the patient was initially diagnosed with androgenetic alopecia and treated with minoxidil. She did not improve with minoxidil. The patient ultimately had a scalp biopsy which showed morpheaform basal cell carcinoma (BCC)

Scalp photos (left) and trichoscopic photos (right) from a 74 year old patient with basal cell carcinoma mimicking androgenetic alopecia. This is a form of alopecia neoplastica. Tomasini CF et al. Giant Morpheaform Basal Cell Carcinoma Mimicking Scarring Alopecia: Exception Prone to Neglect. Dermatopathology (Basel) . 2024 Jun 5;11(2):154-160. doi: 10.3390/dermatopathology11020016.

COMMENT

This was an interesting case of quite a subtle clinical presentation of alopecia neoplastica. It is a nice reminder that we always need to consider a biopsy when something does not seem quite right or a patient does not respond to therapy or when a patient’s past medical history broadens the possible differential diagnosis. The possibility of alopecia neoplastica must be considered in all patients with a prior history of cancer. What was interesting in this case is that the patient ended up having alopecia neoplastica - just not from prior breast cancer.

The authors remind us that secondary alopecia neoplastica due to morpheaform BCC on the scalp is an exceedingly rare condition. However, it possesses subtle clinical features that may mimic both scarring and non-scarring alopecia. Early recognition will limit the ability of this tumor to cause extensive local destruction.

REFERENCE

Tomasini CF et al. Giant Morpheaform Basal Cell Carcinoma Mimicking Scarring Alopecia: Exception Prone to Neglect. Dermatopathology (Basel) . 2024 Jun 5;11(2):154-160. doi: 10.3390/dermatopathology11020016.