Primary epithelioid sarcoma of the scalp complicated by humoral hypercalcemia of malignancy

A 32-year-old man was referred to the Clinic of Plastic Surgery for evaluation of an enlarging, nonhealing lesion on the scalp that had been present for 12 months. The patient was somnolent and dehydrated. Serum calcium level was 4.5 mmol/L (normal 2.1–2.6 mmol/L). Incisional biopsies from 4 quadrants demonstrated an epithelioid sarcoma comprising epithelioid cells and discrete areas of central necrosis. Plain skull radiographs showed bony erosion. Full-body computed tomographic scans confirmed a soft-tissue mass fixed to the skull and multiple metastatic nodules in the cervical lymph nodes and both lungs.