A painful scalp metastasis from sarcomatoid lung cancer

What happened, in summary

A 57-year-old woman who had never smoked first sought care for left-sided pain in early 2019. By July, she had developed a painless swelling over her left tenth rib. Imaging revealed a 40 mm left lower-lobe lung tumor with hilar and mediastinal lymphadenopathy and metastases involving the chest wall, liver, and right gluteal region. Biopsy of the rib mass identified a non-small cell lung carcinoma with pleomorphic sarcomatoid features, classified as stage IV disease.

Carboplatin and pemetrexed were started with pembrolizumab in September 2019. Palliative radiation of 20 Gy in five fractions to the chest wall reduced the soft-tissue mass and eased her symptoms. By early 2020, however, treatment had to be stopped because she developed transfusion-resistant autoimmune haemolytic anaemia and severe immune-related colitis. A further liver lesion confirmed progression, and no targetable mutations were identified.

During this period, a scalp lump that had initially been regarded as a cyst continued to enlarge, ulcerate, and interfere with sleep. After seeking another opinion, she underwent biopsy, which showed a malignant spindle-cell tumor matching the original lung cancer. She chose surgical removal despite concerns about healing, and the defect required a skin graft. She described substantial relief and satisfaction with the result. Her experience centered on persistent self-advocacy, symptom relief, and the psychological importance of treating a visible and painful metastasis even while her overall cancer remained progressive.