title: Solitary scalp metastasis - a rare presentation of hepatocellular carcinoma.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) is among the commonest cancers in the world. Metastasis is one of the most significant factors affecting prognosis. Common sites of extrahepatic metastases include lungs, regional lymph nodes and less commonly bone.
  
  
  METHODS
  A 56-year-old male presented with a painless occipital scalp lump of three months duration, with recent rapid enlargement. His skull x-ray showed a lytic lesion over occipital bone and the contrast CT scan of the brain showed a scalp mass with destruction of the adjacent skull. Core biopsy of the lesion revealed a metastatic deposit from a hepatocellular carcinoma.
  
  
  CONCLUSIONS
  Primary presentation with skeletal metastases are rare in HCC with only a few reported cases. Here we report a case of HCC presenting as a solitary scalp lump.
authors.affiliation: University Surgical Unit, The National Hospital of Sri Lanka, Colombo, Sri Lanka.
authors.forename: Duminda
authors.initials: D
authors.lastname: Subasinghe
authors.affiliation: Department of Neurosurgery, The National Hospital of Sri Lanka, Colombo, Sri Lanka.
authors.forename: Chathuranga Tisara
authors.initials: CT
authors.lastname: Keppetiyagama
authors.affiliation: University Surgical Unit, The National Hospital of Sri Lanka, Colombo, Sri Lanka.
authors.forename: Hemantha
authors.initials: H
authors.lastname: Sudasinghe
authors.affiliation: Department of Neurosurgery, The National Hospital of Sri Lanka, Colombo, Sri Lanka.
authors.forename: Saman
authors.initials: S
authors.lastname: Wadanamby
authors.affiliation: Department of Pathology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
authors.forename: Niranthi
authors.initials: N
authors.lastname: Perera
authors.affiliation: University Surgical Unit, The National Hospital of Sri Lanka, Colombo, Sri Lanka ; Department of Surgery, Faculty of Medicine, Kynsey Road, Colombo 8, Colombo, Sri, Lanka.
authors.forename: Sivasuriya
authors.initials: S
authors.lastname: Sivaganesh
keywords: Hepatocellular carcinoma; Skull metastasis