Cutaneous Carcinosarcoma of the Scalp - A Case Report and Literature Review

Carcinosarcomas are a group of biphasic tumours. They are composed of co-existing malignant epithelial and mesenchymal components. They are extremely rare in the skin. We present a case of a 43 year old female patient who came as a referral from a local district hospital with a chronic painless mass for 7 years. It had ulcerated 6 months prior to presentation with bleeding. The scalp mass was resected with a 10 mm margin. The histological diagnosis was carcinosarcoma as both carcinomatous and sarcomatous. Diagnosis of carcinosarcoma rests on demonstration of pleomorphic spindle cells with pressence of both epithelial and mesenchymal elements within the same tumour. The biphasic nature of the tumour may be seen on light microscopy showing atypical squamoid epithelial cells admixed with mucoid secreting variants as shown in our case. Immunopositivity to both cytokeratin and vimentin on a background of the described light microscopy findings confirms the diagnosis. Generally, surgery with resection of at least 10mm margin is the primary therapeutic modality. Local spread is rare. In conclusion, cutaneous carcinosarcoma of the scalp is rare and management is patient dependant with surgery being the mainstay treatment