ArticleAME case reports2026
Initial clinical diagnosis of a pilar cyst revised to sebaceous carcinoma of the occipital scalp in a 36-year-old male: a case report.
Article in AME case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Sebaceous carcinoma (SC) is a rare malignant tumor originating from skin appendages. Most cases occur in the periocular region, whereas extraocular SC accounts for only about 25% of cases and is especially rare on the scalp. Extraocular SC often presents without characteristic clinical features, frequently leading to misdiagnosis as benign lesions, such as epidermal cysts. Here, we report a 36-year-old male with an atypical presentation of extraocular SC in the occipital region, highlighting its diagnostic challenges and clinical importance. Case Description: Our patient presented with a slowly enlarging subcutaneous mass in the left occipital region that had persisted for more than 2 months. The mass was non-tender, showed no ulceration, and had not increased rapidly in size, mimicking benign lesions such as an epidermal cyst. There was no family history of malignancies or hereditary dermatological disorders. Color Doppler ultrasonography revealed a hypoechoic scalp nodule measuring approximately 2.3 cm × 2.0 cm × 1.0 cm. The lesion was initially diagnosed as a pilar cyst and surgically excised. Histopathological examination demonstrated a large epithelial-derived tumor characterized by indistinct margins and asymmetry. Immunohistochemical analysis showed androgen receptor (AR; +), P63(+), gross cystic disease fluid protein-15 (GCDFP-15; -), and Ki-67(+, 30%). The diagnosis was confirmed as SC of the left occipital region. Mohs micrographic surgery was recommended; however, the patient was lost to follow-up. Conclusions: This case illustrates that extraocular SC of the scalp can be easily misdiagnosed as a benign cyst owing to its atypical presentation. Imaging alone is insufficient for a definitive diagnosis. Clinicians should remain alert to red flags suggesting malignancy in scalp lesions, including firm consistency, persistent growth, poorly defined margins, and unusual clinical features, regardless of patient age. Early skin biopsy remains the gold standard for accurate and timely diagnosis. This case underscores the importance of recognizing rare extraocular SC to prevent misdiagnosis and delays in treatment.
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