Breast cancer scalp metastasis as first metastatic site after scalp cooling: two cases of occurrence after 7- and 9-year follow-up.

Chemotherapy-induced alopecia is a commonly feared chemotherapy side effect and can be prevented using scalp cooling. Scalp metastasis is a rare site of recurrence. There is a question about whether or not the risk might be increased with the use of scalp cooling. Two cases of breast cancer with scalp metastases as first metastatic site are presented. The first patient presented with a scalp metastasis as first metastatic site 9 years following breast cancer chemotherapy treatments; she used scalp cooling for the adjuvant treatment. Second case presented a scalp metastasis as first metastatic site 7 years following treatments for her first cancer; overall, she used scalp cooling in only one of her six adjuvant chemotherapy cycles. Scalp metastases as the first site of recurrence are very rare entities. Scalp cooling is unlikely to have contributed in the cases presented here.