Scalp nodules as the first presentation of prostate cancer: A CARE-compliant article

Rationale: Bones are the most common site of prostate cancer metastasis. Other common sites of metastases include the distant lymph nodes, liver, thorax, brain, and digestive system. However, cutaneous metastases from prostate cancer are extremely rare. Patient concerns: We present a case of a 61-year-old man with scalp nodules without any cancer history. Diagnosis: The patient was diagnosed with metastatic prostate adenocarcinoma through an incisional biopsy for his scalp nodules. The patient presented with a serum prostate-specific antigen level of 10.2 ng/mL; imaging examinations revealed extraprostatic extension, lymph node involvement, and multiple bone metastases. Intervention: The patient was treated with androgen deprivation therapy with leuprolide acetate (7.5 mg every month) and abiraterone acetate (1000 mg daily). Outcomes: The scalp metastases resolved without adverse effects, and the serum prostate-specific antigen level decreased to 0.02 ng/mL. Lessons: Cutaneous metastasis, especially scalp metastasis from prostate cancer, is extremely rare. If there is a rash or nodule on the skin, it is necessary to evaluate it carefully and to confirm it through a biopsy.