Squamous Cell Carcinoma on the Scalp After Use of a Wig for 30 Years

Sir,

In this article, we report a case of a squamous cell carcinoma after use of a wig for 30 years to provide new insights on the possible complications related to use of a wig and remind the clinicians to look even under a wig when doing dermatologic investigations. Squamous cell carcinoma is accounted for 20% of skin cancers. The most significant factor in the aetiology is the sunlight. Other important factors are chemical carcinogens, chronic irritation, smoking and human papillomavirus infection.[12] The neoplasm in the presented case could be possibly related to a recurrent local injury (cleaning supplies and adhesive chemicals for the wig etc.), repetitive irritation and microtrauma in the basis of previous ultraviolet (UV) exposure.

An 84-year-old female patient was brought to our clinic because of the wound on the scalp [Figure 1]. There were not any history of trauma, long-term UV exposure and family history of tumours. However, she had been wearing a wig for 30 years because of alopesia. She had folliculitis decalvans, which is a rare inflammatory scalp disorder and can cause cicatricial alopesia and she used several antibiotic and corticosteroid treatments in the past.[3] Patient did not know how long she had the wound on scalp. She used some topical drugs for the wound and was not mind the wound anyway. Her girl realised the wound by chance and brought the patient to our clinic. We suspected a tumour and applied wide excision and skin grafting surgery, later the lesion's pathology was reported as squamous cell carcinoma.

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Figure 1

Squamous cell carcinoma on the scalp

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We came across one similar publication in the literature. Craiglow and King determined squamous cell carcinoma on the scalp under a toupee by chance while examining the 86-year-old male patient for a lesion on her nose.[4] Wig use can be accepted a skin irritant. Especially in patients at high risk for skin cancer and had skin cancer previously a complete physical examination is important.

Patients using a wig for a long time must be evaluated for skin cancers on the scalp and their relatives should be informed of this issue and because the tumours can be hidden under a wig.