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This case report describes a 63-year-old woman with a nodular scalp lesion as the initial presentation of primary pulmonary large cell neuroendocrine carcinoma. She had no pulmonary symptoms and no smoking or pulmonary disease history. Subsequent clinical assessment and biopsy revealed intradermal cord-like tumor invasion consistent with a pulmonary-origin pattern and lymphovascular involvement.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/nodular-scalp-mass-as-the-first-presentation-of-pulmonary-large-cell-neuroendocrine-carcinoma-a-case-report/383017/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/nodular-scalp-mass-as-the-first-presentation-of-pulmonary-large-cell-neuroendocrine-carcinoma-a-case-report/383017.png","ImageObject",300,407,{"name":92,"@type":93},"Jasmine","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-24",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is a scalp skin lesion considered an unusual first presentation of lung cancer?","Question",{"text":112,"@type":113},"Skin metastasis from lung cancer is uncommon, and it is extremely rare for skin metastasis to be the first manifestation. In reported cases, patients often had heavy smoking history or preexisting respiratory disease, making this presentation atypical.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What were the key clinical features of the patient’s scalp mass?",{"text":117,"@type":113},"A 63-year-old woman presented with an asymptomatic, gradually enlarging right parietal scalp nodule. The lesion was light pink, firm and round, about 0.8 × 0.7 cm, with ulceration and no associated pain or tenderness.",{"name":119,"@type":110,"acceptedAnswer":120},"What did the initial pathological examination show?",{"text":121,"@type":113},"The initial pathology revealed intradermal, cord-like tumor invasion. The histologic appearance was similar to a lung tumor and indicated lymphovascular invasion.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},383017,1790770602,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":52},2336478487870,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Case Report  \nArchives of Craniofacial Surgery  \nArch Craniofac Surg Vol.24 No.5, 240-243 [https://doi.org/10.7181/acfs.2023.00304](https://doi.org/10.7181/acfs.2023.00304)  \nNodular scalp mass as the first presentation of pulmonary large cell neuroendocrine carcinoma: a case report  \nHong Won Lee, Young Joong Hwang, Sung Gyun Jung, In Pyo Hong  \nDepartment of Plastic and Reconstructive Surgery, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea  \nMetastasis of lung cancer to the skin is uncommon, presenting in 0.22% to 12% of lung cancer patients, and it is extremely rare for skin metastasis to be the first clinical manifestation of lung cancer. In the few cases where skin metastasis has been reported as the first sign of lung cancer, the patients were typically heavy smokers or had preexisting respiratory diseases and symptoms. This prompted clinicians to consider skin metastasis of a pulmonary malignancy. Large cell neuroendocrine carcinoma (LCNEC) is a rare type of lung cancer that accounts for approximately 3% of lung cancers. LCNEC mainly metastasizes to visceral organs, such as the liver, bone, and brain, and it only shows metastasis to the skin in very rare cases. Herein, we report an unusual case of a metastatic skin lesion as the first sign of primary pulmonary LCNEC, in a 63-year-old woman with no pulmonary symptoms or personal history of smoking or pulmonary disease.  \nAbbreviations: LCNEC, large cell neuroendocrine carcinoma; LLL, left lower lobe; PET-CT, positron emission tomography-computed tomography  \nKeywords: Carcinoma / Case reports / Neoplasm metastasis / Neuroendocrine carcinoma / Non-small-cell lung carcinoma  \nINTRODUCTION  \nLarge cell neuroendocrine carcinoma (LCNEC) is a rare subtype of lung cancer, accounting for 1% to 3% of all lung cancers, and is known for its aggressive behavior [1]. The aggressive nature of LCNEC, coupled with uncommon pulmonary symptoms such as cough, hemoptysis, and post-obstructive pneumonia, makes it difficult to diagnose in its early stages. Unlike other lung cancers, LCNEC is often discovered in advanced stages. Furthermore, ap-  \nCorrespondence: In Pyo Hong  \nDepartment of Plastic and Reconstructive Surgery, Daejeon Eulji Medical Center, Eulji University, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Korea [E-mail: 20150601@eulji.ac.kr](E-mail: 20150601@eulji.ac.kr)  \nHow to cite this article:  \nLee HW, Hwang YJ, Jung SG, Hong IP. Nodular scalp mass as the first presentation of pulmonary large cell neuroendocrine carcinoma: a case report. Arch Craniofac Surg 2023;24(5):240-243. [https://doi.org/10.7181/acfs.2023.00304](https://doi.org/10.7181/acfs.2023.00304)  \n[Received June 12](Received June 12), [2023 / Revised June 28](2023 / Revised June 28), [2023 / Accepted October 9](2023 / Accepted October 9), [2023](2023)  \nproximately 40% of patients present with distant metastases to the liver, bone, and brain at the time of diagnosis [2,3]. A previous study reported that skin metastasis, an uncommon clinical symptom of pulmonary malignancy, is found in 0.22% to 12% of patients with lung cancer [4]. According to a report by Hidaka et al. [5], 15 out of 16 patients with skin metastasis of pulmonary malignancy were grade 4 and exhibited metastases to other organs such as the bone, brain, lung, and liver, in addition to the skin. The occurrence of skin metastasis as the initial presentation of lung cancer is extremely rare, and it suggests a poor prognosis. There have been few reported cases of skin metastasis from pulmonary malignancy as the first presentation [4,6,7]. However, it is rare for non-smokers to be diagnosed with pulmonary LCNEC through an initial skin presentation, without any respiratory or systemic symptoms; therefore, we report this case.  \nCopyright © 2023 Korean Cleft Palate-CraniofacialAssociation  \nThis is an OpenAccess article distributed under the terms of the Creative CommonsAttribution Non-Commercial License ([https://creativecommons.org/](https://c","cbCaibXAZtW3pb52","https://ap.wps.com/l/cbCaibXAZtW3pb52","pdf",448051,"English","# Introduction\n# Case Report\n## Clinical presentation and excision\n## Pathologic findings","[{\"question\":\"Why is a scalp skin lesion considered an unusual first presentation of lung cancer?\",\"answer\":\"Skin metastasis from lung cancer is uncommon, and it is extremely rare for skin metastasis to be the first manifestation. In reported cases, patients often had heavy smoking history or preexisting respiratory disease, making this presentation atypical.\"},{\"question\":\"What were the key clinical features of the patient’s scalp mass?\",\"answer\":\"A 63-year-old woman presented with an asymptomatic, gradually enlarging right parietal scalp nodule. The lesion was light pink, firm and round, about 0.8 × 0.7 cm, with ulceration and no associated pain or tenderness.\"},{\"question\":\"What did the initial pathological examination show?\",\"answer\":\"The initial pathology revealed intradermal, cord-like tumor invasion. The histologic appearance was similar to a lung tumor and indicated lymphovascular invasion.\"}]","Nodular scalp mass as the first presentation of pulmonary large cell neuroendocrine carcinoma - a case report | PDF",1790253645]