Primary Cutaneous Apocrine Carcinoma of the Scalp With Satellite Lesions: An Exceptionally Rare Presentation.

Primary cutaneous apocrine carcinoma (PCAC) of the scalp is extremely rare, and cases presenting with multiple satellite lesions are even rarer. The authors report a huge ulcerative scalp mass, initially presumed to be metastatic adenocarcinoma, that was later confirmed as primary PCAC following comprehensive diagnostic evaluation. The tumor had remained untreated for nearly a decade, resulting in extensive skull invasion and multiple satellite deposits around the primary lesion. A multidisciplinary surgical strategy involving wide excision, neurosurgical craniectomy with titanium cranioplasty, and anterolateral thigh (ALT) free flap reconstruction using dual recipient vein anastomosis was performed. This case emphasizes the importance of early recognition and aggressive management of scalp PCAC, particularly when satellite lesions suggest lymphatic dissemination.