Paediatric Scalp Squamous Cell Carcinoma With Suspected Intracranial Extension Mimicking Cerebral Abscesses in a Patient With Xeroderma Pigmentosum: A Case Report and Literature Review Abstract

Abstract

Objective: Squamous Cell Carcinoma (SCC) is among the most frequently reported malignancies in XP; however, intracranial extension is exceedingly rare and may pose a significant diagnostic challenge when radiologic findings mimic those of cerebral abscess.

Methods: The case of a 7-year-old male child with XP who developed an ulcerative lesion on the scalp and underwent surgical excision is reported. Xeroderma Pigmentosum (XP) is a rare autosomal recessive genodermatosis characterized by extreme sensitivity to ultraviolet radiation and an increased predisposition to cutaneous malignancies.

Result: The excised tissue from the Histopathology confirmed moderately differentiated SCC with lymphovascular invasion and involvement of the deep margins. He subsequently presented with fever, vomiting, and seizures at National Institute of Child Health (NICH), Karachi, on 3rd March 2026. Contrast-Enhanced Computed Tomography (CECT) revealed bone destruction with an overlying mass and multiloculated intracranial lesions with a “bunch of grapes” appearance. The differential diagnosis included cerebral abscess and tumour extension. The family declined further evaluation and treatment, and the patient Left Against Medical Advice (LAMA). The patient deteriorated clinically and subsequently died as informed by his parents

Conclusion: XP-associated scalp SCC may behave aggressively and extend intracranially, even in children. In patients with a history of malignancy, intracranial lesions with an apparent infectious appearance should prompt careful consideration of tumour extension in the differential diagnosis. Recognition of suspicious neuroimaging features, careful radiologic-pathologic correlation, early multidisciplinary evaluation, and timely management are essential to optimize outcomes.The parents consented to publish the child’s report in detail.