Quadruple Primary Malignancy of the Scalp, Colon, and Prostate in a Single Patient: A Unique Case Report and Review of Literature

Multiple primary malignancies are rare but early detection can be achieved with the advent of advanced imaging techniques. Diagnosis of all synchronous malignancy is vital for planning and favorable outcome. In this study, we present a case of synchronous triple primary malignancy consisting of squamous carcinoma scalp, adenocarcinoma prostate, and adenocarcinoma ascending colon with history of sigmoid colon cancer 11 years back. There were 12 possible treatment options and three alternative treatment sequences. Multidisciplinary tumor board team decided to begin the treatment with hormonal therapy (Enzalutamide/Leuprolide) for advanced metastatic prostate cancers. This was followed by simultaneous surgery consisting of wide excision of the right scalp lesion and right hemicolectomy. After a year of follow-up, patient remained disease progression free. This is the first quadruple malignancy case described in literature with the combination of scalp, prostate, and colon cancers as triple synchronous malignancy. Each cancer had its own diagnostic and treatment dilemma. Collectively, sequence of management of each cancer was also a predicament. Multidisciplinary management plays a pivotal role in the successful management of synchronous malignant tumors.