Neoplastic skin lesions of the scalp in children: A retrospective study of 265 cases in Taiwan

Background: The preferential occurrence of certain skin neoplasms on the scalp of children raises concerns from their parents and warrants special diagnostic and therapeutic approaches. Objective: To explore the demographic and clinical characteristics of scalp neoplasms in the pediatric population, with attention to malignant tumors and systemic syndromes. Methods: Scalp neoplasms in patients aged 12 years or younger were retrospectively collected in 1990-2010 from two tertiary referral centers in Taiwan. Results: A total of 267 scalp neoplasms in 265 pediatric patients were recruited. Among the 209 neoplasms with a histopathological diagnosis, nevus sebaceus was the most common (67.9%), followed by melanocytic nevus (6.2%) and juvenile xanthogranuloma (6.2%). Most of the scalp neoplasms (77.9%) were seen at birth or before 1 month of age. Infantile hemangioma was clinically diagnosed without histology in 41.4% of cases. Malignant scalp tumors were identified in two patients (0.95%), with one basal cell carcinoma and one precursor B-cell lymphoblastic lymphoma, respectively. Scalp neoplasms in association with systemic syndromes were found in two cases. One had neurofibromatosis type I with juvenile xanthogranuloma and the other basal cell nevus syndrome with basal cell carcinoma. Conclusions: Most pediatric scalp neoplasms in our study were hamartomas or teratomas. Malignant scalp tumors and malignant transformation of nevus sebaceus were rare. A detailed medical history taking and complete physical examinations are needed to exclude possible associations with systemic syndromes or malignancies.