• Gokhan Giray Akgul, Erdinc Yenidogan, Soykan Dinc, Isin Pak, Muhammet Kadri Colakoglu, and Mehmet Ali Gulcelik.
• Ankara Oncology Training and Research Hospital, Department of General Surgery, 06100 Ankara, Turkey.
• Int J Surg Case Rep. 2013 Jan 1; 4 (7): 589-92.

IntroductionCylindromas are usually benign tumors as small, solitary, slow-growing nodules of the scalp, face and trunk. Multiple cylindromas may form a "turban tumors" in the autosomal dominant Brooke-Spiegler syndrome. Malignant dermal cylindromas are very rare. There are few cases of malignant transformation of dermal cylindromas in the literature. We present an unusual case of malign cylindroma of the scalp with multiple metastasis to cervical lymph nodules and also this case is the only case that has the most lymph node metastasis.Presentation Of CaseA 52-year-old man initially presented to our clinic with hyperemic plaque located on his scalp. Measures of the plaque was 20cm×10cm with bilateral, multiple palpable submandibulary lymph nodes. Entire scalp was removed reaching in depth the periostal level and bilateral modified radical neck dissection was performed. The histopathological examination of the scalp specimen was malignant skin ecrine tumor, cylindroma and on the neck dissection specimen, 55 lymph nodes were reported as metastatic out of 79. The patient was treated with chemotherapy and radiotherapy. No recurrence or metastasis was observed during a 5 year follow-up period.DiscussionMalign cylindroma of the scalp rarely presents with multiple cervical lymph node metastasis, however it is important to be aware of this possibility.ConclusionThe case reported below is outstanding in literature for being the only case that has the most lymph node metastasis. Although malign transformation of dermal cylindromas is rare, aggressive surgery should be considered with locoregional metastasis of the tumor.Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

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