Characterization of distinct microbiota associated with androgenetic alopecia patients treated and untreated with platelet-rich plasma(PRP)

Background:Androgenic alopecia(AGA)is the most common type of hair loss in men,and there are many studies on the treatment of hair loss by platelet-rich plasma(PRP).The human scalp contains a huge microbiome,but its role in the process of hair loss remains unclear,and the relationship between PRP and the microbiome needs further study.Therefore,the purpose of this study was to investigate the effect of PRP treatment on scalp microbiota composition.Methods:We performed PRP treatment on 14 patients with AGA,observed their clinical efficacy,and collected scalp swab samples before and after treatment.The scalp microflora of AGA patients before and after treatment was characterized by amplifying the V3-V4 region of the 16 s RNA gene and sequencing for bacterial identification.Results:The results showed that PRP was effective in the treatment of AGA patients,and the hair growth increased significantly.The results of relative abundance analysis of microbiota showed that after treatment,g_Cutibacterium increased and g_Staphylococcus decreased,which played a stable role in scalp microbiota.In addition,g_Lawsonella decreased,indicating that the scalp oil production decreased after treatment.Conclusions:The findings suggest that PRP may play a role in treating AGA through scalp microbiome rebalancing.

Mechanism of acupuncture for limb spasm of post-stroke spasticity based on GABA and BDNF/Trkb-KCC2 signaling pathway

Background:To investigate the effects of acupuncture on post-stroke limb spasm model rats and the underlying mechanism.Methods:A total of 50 Sprague-Dawley rats were randomly divided into three groups,Control group(10),Model group(20)and Zhishen Tiaoxing(ZSTX)acupuncture group(20).Middle cerebral artery occlusion was conducted in SD rats to establish post-stroke limb spasm rats,which were treated with ZSTX acupuncture.Behavioral assays were determined by the Narrow ally test,the limb muscle tension was detected by the BL-420S test system,and infarct volume was assessed after the cerebral infarction by 2,3,5-triphenyltetrazolium chloride staining.Heterogeneous neurotransmitterγ-aminobutyric acid(GABA)and its receptors GABAA and GABAB in the cerebral cortex of the infarct area were determined by immunofluorescence assay.The release of Trkb and K-Cl cotransporter isoform 2 was detected by an immunofluorescence double labeling study.Western Blot was utilized to measure the expression of BDNF and Trkb.Results:The results showed that the behavioral assays in post-stroke limb spasm rats were significantly improved by the treatment of ZSTX acupuncture.14 days of ZSTX acupuncture can effectively inhibit muscle tone and decrease Infarct volume,which was measured with BL-420S biological function experiment system and triphenyltetrazolium chloride.Meanwhile,the results of Double-Label Immunofluorescence Assays showed that ZSTX acupuncture improved the expression of GABA,GABAA,GABAB,BDNF,and K-Cl cotransporter isoform 2.Double-Label Immunofluorescence Assays and WB results showed that 14 days ZSTX acupuncture declined the expression of Trkb.Conclusions:Our results suggest that 14 days of ZSTX acupuncture can significantly improve post-stroke limb spasm.Meanwhile,the pathogenesis of post-stroke limb spasm and the efficacy of ZSTX acupuncture involve metabolic pathways of neurotransmitters,and electro-acupuncture can treat post-stroke limb spasm by regulating BDNF/Trkb-KCC2 signaling pathway.

Adaptability of bipedicled scalp advancement flap for coverage of huge scalp defects after tumor resection

Background:Several reconstructive techniques have been used to reconstruct scalp defects.Numerous researchers have studied the utilization of bipedicled scalp advancement flaps for scalp defect coverage.In this study,we will assess the adaptability of a bipedicled scalp advancement flap for coverage of huge scalp defects after tumor resection.Methods:This study was performed at the Plastic Surgery Department,Fayoum University Hospital,on 20 patients with huge scalp tumors treated by adequate excision and reconstructed using a bipedicled scalp advancement flap from December 2021 to July 2023.Results:The study was conducted on 20 patients:16(80%)were men and 4(20%)were women presenting with large scalp tumors.The mean age was 57.4 years(33-68 years).The sites of the tumors were 10(50%)occipital,6(30%)parietal,and 4(20%)parieto-occipital.No major complications occurred postoperatively,and the bipedicled flaps survived well in all cases,with no necrosis.Conclusion:Huge scalp defects after tumor resection can be safely reconstructed with a large versatile bipedicled advancement scalp flap,either transversely or longitudinally oriented,with favorable functional results and accepted aesthetic results,apart from the alopecic area over the grafted donor site,which can be treated by tissue expansion if desired later.

Scalping or Line-sitting:The Role of Speculators

Speculative behaviors have burgeoned in various business settings whereby it is costly for consumers to purchase directly from sellers.This paper examines the values of two typical speculative behaviors,scalping and line-sitting,against a backdrop of markets with resale.We establish a two-stage model in which a monopolist seller sells an item(product or service)to consumers in the first stage,and the item can be traded on a resale platform in the second stage.Speculators have no interests in consumption but incur lower costs in pm-chasing and reselling processes than consumers.In the scalping model,they buy the item first and resell it later to make profits.In the line-sitting model,they earn incomes by serving as surrogates of consumers in purchasing.We first find whether the two phenomena emerge critically depends on the value of consumers'entry cost.Our main results indicate that both speculative behaviors can bring benefits to the seller and resale platform by a demand expansion effect,although through different mechanisms.Under scalping,the entry of speculators as additional buyers always boosts demand in both stages,and achieves a win-win outcome for the seller and platform,although less consumers remain in the market and the resale price decreases.Under line-sitting,demand is enlarged and profits rise in both stages,only when consumers find purchasing directly more time-and money-consuming,because they need to pay an extra service fee to speculators.Moreover,the consumer population gets better off from the two speculative behaviors when their entry cost is relatively high.When both models emerge,scalping may be preferable to line-sitting for the seller,resale platform and consumers,if the cost advantage of speculators in resale transactions is more evident.

Giant Cerebriform Nevus Cell Nevus of the Scalp: A Case Report

Giant cerebriform nevus cell nevus of the scalp is an extremely rare form of congenital melanocytic nevus. Giant cerebriform nevus of the scalp has a major psychosocial impact because of its unsightly appearance with fetid maceration. We report the case of a 35-year-old woman who had a painless, malodorous swelling of the cerebriform scalp measuring 20 × 17 cm in diameter with a wide base of insertion at the occipital level adhering to the deep planes. The excision associated with a skin plasty was carried out. Histology concluded that there was a giant cerebriform naevo-cellular nevus of the scalp.

Misdiagnosis of scalp angiosarcoma: A case report

BACKGROUND Angiosarcoma is a rare malignant tumor.Owing to the lack of specific clinical manifestations of this disease,it is difficult to achieve early diagnosis and start early treatment.CASE SUMMARY A 78-year-old male patient was admitted to the hospital because of a bump on his head that did not heal for 4 mo.The patient was diagnosed with a refractory head wound.The patient underwent neoplasm resection and skin grafting surgery in the Plastic Surgery.The neoplasm was sent for pathological examination during the operation.The final pathological results were confirmed scalp angiosarcoma.CONCLUSION Our research suggests that pathological examination should be performed for refractory ulcers of the scalp,and physical factor therapy should be used with caution before the diagnosis is clear.

Effect of scalp acupuncture combined with language rehabilitation training in treating post-stroke motor aphasia:A systematic review and meta-analysis

Objective:To evaluate the efficacy of scalp acupuncture combined with language rehabilitation training in the treatment of motor aphasia.Methods:CNKI,VIP,Wan Fang Database,MEDLINE,Embase,Web of Science and Cochrane Library were searched for published researches up to March,2021.Randomized controlled trials RCTs that focused on scalp acupuncture combined with language rehabilitation training in the treatment of motor aphasia were included.We managed the data analysis with RevMan 5.3 software.Results:A total of 16 RCTs with 1323 patients were involved.The results of meta-analysis showed that:①The effective rate of scalp acupuncture combined with language rehabilitation training in the treatment of motor aphasia after stroke was significantly better than that of simple language rehabilitation training[OR=3.94,95%CI(2.73,5.68),P<0.00001];②In the evaluation of language function,compared with the language rehabilitation training,the scalp acupuncture combined with language rehabilitation training can significantly improve the reading ability of the patients with motor aphasia after stroke[MD=7.22,95%CI(3.55,10.89),P=0.0001],writing ability[MD=6.51,95%CI(3.61,9.41),P<0.0001],expressive ability[MD=4.13,95%CI(2.37,5.89),P<0.0001],retelling ability[MD=5.00,95%CI(2.38,7.63),P=0.0002],listening comprehension ability[MD=5.36,95%CI(3.12,7.61),P<0.00001]and naming ability[MD=5.60,95%CI(4.20,7.00),P<0.00001];③Compared with simple language rehabilitation training,scalp acupuncture combined with language rehabilitation can significantly improve the daily life language communication ability of patients with motor aphasia,and the difference was statistically significant[MD=30.01,95%CI(11.30,48.72),P=0.002].Conclusion:Scalp acupuncture combined with language rehabilitation training has a significant effect on motor aphasia.However,due to the small sample size,more RCTs are needed to confirm that.

A potential long-term complication to two-segment total scalp replantation and how to treat it

Total avulsion of the scalp is a serious traumatic injury and an absolute surgical emergency.Despite well-stocked literature on its immediate care,there is insufficient literature regarding its long-term complications.Here,we describe the case of a patient who developed chronic pain 24 months after replantation.The patient underwent several needle rigotomy sessions associated with lipofilling to reconstruct a sliding plane between the scalp and periosteum,followed by nanofat sessions to improve skin elasticity.This autologous fat injection treatment was successful,and the patient is currently pain-free.Therefore,lipofilling followed by nanofat injection is an effective treatment for this complication.

Mechanism of Scalp Acupuncture Combined with Distal Acupoint Selection in the Treatment of Vascular Headache Caused by Hyperactivity of Liver-Yang

The clinical effect of acupuncture on vascular headache caused by hyperactivity of liver-yang has been shown, but the specific mechanism is not yet clear. This paper is intended to discuss the etiology and pathogenesis of vascular headache caused by hyperactivity of liver-yang and the mechanism of acupuncture, so as to provide a certain reference for clinical diagnosis and treatment of scalp acupuncture treatment of vascular headache caused by hyperactivity of liver-yang.

Advanced Cutaneous Scalp Eccrine Adenocarcinoma, Diagnosis and Treatment Challenges: A Case Report

In Madagascar, a country with a tropical climate;skin cancers are often of epidermal or melanic origin. Adnexal tumors are not well known. We report the first case of an eccrine tumor in a 57-year-old woman with no personal or family history of cancer. She has no comorbidities. The patient presented with a 50 × 60 mm frontal swelling and an ulcerative lesion of the left half of the face that had been evolving for 5 months. The cerebral and cervical CT scan revealed bone lysis of the vault of the skull and left cervical lymphadenopathy. The CT chest-abdomen-pelvis showed no abnormal lesions. The mammogram was normal. The result of the pathological examination was in favor of a round-cell tumor. The AE1/AE3, CK7 and P63 markers were positive in the immunohistochemical study. The diagnosis of an advanced eccrine adenocarcinoma was retained after the exclusion of a visceral adenocarcinoma with cutaneous metastasis. The patient receives radiotherapy of 40 Gy in 20 fractions followed by 6 courses of Carboplatin-paclitaxel type chemotherapy. The lesion has decreased in size and dried up after these treatments. 3 months after stopping treatment for lack of financial means, the patient died at home. The diagnosis of an adnexal tumor requires more in-depth complementary examinations. Treatments should be multidisciplinary and adapted to each patient.

Application of a jigsaw puzzle flap based on free-style perforator to repair large scalp defects after tumor resection:A case series

Background:Reconstruction of large scalp defects after tumor resection is common and challenging.Free skin grafting or free flap transfer is always performed.However,these techniques can result in poor functional and cosmetic outcomes.Methods:In the Second Affiliated Hospital of Soochow University and the Second Affiliated Hospital of Chengdu Medical College,35 patients underwent jigsaw puzzle flap procedures based on a free-style perforator to repair large scalp defects after tumor resection from May 2013 to November 2022.The key to this procedure was to divide a large defect into several smaller parts that correspond to adjacent free-style perforators around the scalp defect.The free-style perforator flaps were designed in different ways,such as propeller flaps,rotation flaps,and V-Y advancement flaps,which were pedicled with free-style perforators.All of the small flaps were then mobilized to the defect and sutured to each other to create a new,large jigsaw puzzle-like flap to cover the large scalp defect.Finally,all the donor sites were closed directly.Results:Overall,35 patients were treated.The average defect size was 72 cm^(2)(range,25-91 cm^(2)).All flaps had a satisfactory appearance after follow-up periods of 6 months-10 years.Local tumor recurrence occurred in one case.Conclusion:The application of a jigsaw puzzle flap based on a free-style perforator is a suitable option for the reconstruction of large scalp defects after resection,yielding satisfactory functional and cosmetic results.

The Utility of the Galea in Scalp Reconstruction

Total scalp avulsion is a time-sensitive, catastrophic injury requiring quick, complex decision-making. Traditionally, these injuries were treated with split-thickness skin grafts. With advancements in microsurgery, treatments evolved to scalp replantation, becoming the standard of care in scalp reconstruction. Although the integrity of the scalp’s blood vessels is pivotal for successful replantation, the authors believe that scalp replantation should be considered at all costs. In the presented case, a 54-year-old female presented to the emergency room following an incident with an auger that completely avulsed her scalp. She was taken back to the operating room, where scalp replantation was performed. Following replantation, scalp necrosis led to serial debridings in the operating room, and eventually, all of the scalp was debrided down to healthy tissue. Surprisingly, the galea survived despite this, which provided a healthy base for skin grafts. Before definitive coverage was placed, it was decided to utilize a bilaminar acellular dermal matrix along with negative pressure wound therapy to create a more robust bed of granulation tissue. After three weeks of this treatment plan, the patient returned to the operating room, where a healthy, viable bed of granulating tissue was revealed beneath the dermal matrix. Split-thickness skin grafts were taken from her thighs bilaterally and sewn together in a quilt-like fashion to cover the wound bed. The entirety of the graft healed without complication except for one small area that required full-thickness skin grafting in an outpatient setting. Even though the replantation ultimately failed, it allowed the galea to survive, which saved the patient from undergoing a free tissue transfer and allowed her scalp to be reconstructed with split-thickness skin grafts. Even in the setting of polytrauma, the authors hope that anyone treating a scalp avulsion would consider scalp replantation at all costs.

A Rare Tumor of the Scalp: Papilliferous Cystadenoma

Introduction: Papilliferous cystadenoma is a rare adnexal tumor of early childhood. Case Report: We report a case of papilliferous cystadenoma of the scalp in a 22-year-old adult with no previous history of the disease. She had been presenting with a slowly progressing scalp mass for about 10 years. The mass was mildly pruritic and painless, but the patient reported several painful episodes treated with local herbal applications and unspecified antibiotics. On inspection, the lesion was raised, granular, sessile and vegetated, greyish in color, with an irregular surface, nippled and hemispherical in shape. On palpation, the lesion was painless, fleshy and surrounded by crusts that were easily removed by applying a saline-moistened compress. The patient underwent excision with at least 4-mm margins. Pathological examination of the operative specimen revealed a papilliferous syringocystadenoma. There was no tumor recurrence after three years. Conclusion: Papilliferous cystadenoma is a rare benign tumor of the scalp requiring clinical analysis and surgical excision to confirm its histological nature. Post-operative follow-up is necessary due to frequent recurrences.

Curative Effect of 30% Supramolecular Salicylic Acid Combined with Yufa Spray Dressing on Moderate to Severe Scalp Seborrheic Dermatitis

Objective:To observe the clinical efficacy of 30%supramolecular salicylic acid combined with Yufa spray dressing in the treatment of moderate to severe seborrheic dermatitis(seborrheic dermatitis of the scalp,SDS).Methods:From January 2020 to December 2021,150 patients with SDS,who were treated in the Dermatology Clinic of the First Affiliated Hospital of Xi’an Medical University,were randomly divided into two groups,a treatment group and a control group,with 75 cases in each group.The treatment group was given 30%supramolecular salicylic acid combined with Yufa spray dressing on the basis of external medicine given to the control group,while the control group was given oral medicine combined with external medicine.Results:The difference in scores of erythema,scales,pruritus,and folliculitis of the treatment group before and after treatment was significant(P<0.01),indicating that supramolecular salicylic acid combined with Yufa spray dressing can relieve the symptoms of SDS.The difference in scores of erythema of the control group before and after treatment was significant as well(P<0.05),indicating that traditional antibiotics are also effective in treating SDS;however,there was no significant difference(P>0.05)in the scores of other signs and symptoms,such as scales,pruritus,and folliculitis,before and after treatment,indicating that traditional antibiotics have no obvious curative effect on SDS.After 12 weeks of treatment,the improvement in erythema,scaling,and folliculitis was significantly greater in the treatment group compared with the control group(P<0.05).Curative effect comparison showed that the total effective rate of the treatment group was 80.00%,compared with 25.67%of the control group,and the difference was statistically significant(P<0.05).Conclusion:30%supramolecular salicylic acid combined with Yufa spray dressing can significantly improve the therapeutic effect in moderate to severe SDS;the recurrence rate is lower,the course of treatment is shorted,and patients generally feel better;thus,it is a new option for the treatment of dermatitis.

IMPACTS ON THE EXPRESSION OF VASCULAR ENDOTHELIAL GROWTH FACTOR IN ISCHEMIC BRAIN TISSUE TREATED WITH CLUSTER PUNC-TURE ON SCALP ACUPOINTS IN RATS

Objective To probe into the impacts on the expression of vascular endothelial growth factor （VEGF） in ischemic brain tissue treated with cluster puncture on scalp acupoints in rats, Methods 128 rats were randomized into pseudo-operation group, model group, scalp-needling group and cluster-needling group, In scalp-needling group, penetration method was used on the focal side from Bǎihuì （百会 GV20） to Qǔbīn （曲鬓 GB7）, and in cluster-needling group, penetration method was used on both sides from GV20 to GB7, and a common needling on GV 20. Needles were punctured 2 mm in depth, constantly rotated for 10min, retained for 2 h. Immunohistrochemical method was applied to determine VEGF expression and microvessel density （MVD）. Results With the intervention of cluster puncture on scalp acupoints, VEGF： expressions on every time-spot after ischemia were enhanced apparently, superior to those in scalp-needling group. On the three time-spots of the 7^th, 14^th and 21^st days, MVD was increased after cluster puncture on scale acupoints, superior to those in scalp-needling group. Conclusion Cluster puncture on scalp acupoints up-regulated VEGF expression and promoted regeneration of microvessel.

从阿帕奇到SCALP-EG/风暴前兆——欧洲防区外空对地导弹技术发展剖析

法国研制的阿帕奇导弹已正式服役了, 它是西欧第一种防区外发射的空对地导弹, 也是西欧隐身区外导弹的先驱.后来, 在它的基础上又发展了先进的SCALP-EG/风暴前兆导弹, 该导弹在今年3月的伊拉克战争中, 英国空军首次使用.

Modulatory effect of International standard Scalp Acupuncture on brain activation in the elderly as revealed by resting-state fMRI

The specific mechanisms by which acupuncture affects the central nervous system are unclear. In the International Standard Scalp Acupuncture system, acupuncture needles are applied at the middle line of the vertex, anterior parietal-temporal oblique line, and the posterior parietal-temporal oblique line. We conducted a single-arm prospective clinical trial in which seven healthy elderly volunteers (three men and four women;50–70 years old) received International Standard Scalp Acupuncture at MS5 (the mid-sagittal line between Baihui (DU20) and Qianding (DU21)), the left MS6 (line joining Sishencong (EX-HN1) and Xuanli (GB6)), and the left MS7 (line joining DU20 and Qubin (GB7)). After acupuncture, resting-state functional magnetic resonance imaging demonstrated changes in the fractional amplitude of low frequency fluctuations and regional homogeneity in various areas, showing remarkable enhancement of regional homogeneity in the bilateral anterior cingulate, left medial frontal gyrus, supramarginal gyrus, right middle frontal gyrus, and inferior frontal gyrus. Functional connectivity based on a seed region at the right middle frontal gyrus (42, 51, 9) decreased at the bilateral medial superior frontal gyrus. Our data preliminarily indicates that the international standard scalp acupuncture in healthy elderly participants specifcally enhances the correlation between the brain regions involved in cognition and implementation of the brain network regulation system and the surrounding adjacent brain regions. The study was approved by the Ethics Committee of the China-Japan Union Hospital at Jilin University, China, on July 18, 2016 (approval No. 2016ks043).

Immediate effects of scalp acupuncture with twirling reinforcing manipulation on hemiplegia following acute ischemic stroke: a hidden association study

Data mining has the potential to provide information for improving clinical acupuncture strategies by uncovering hidden rules between acupuncture manipulation and therapeutic effects in a data set. In this study, we performed acupuncture on 30 patients with hemiplegia due to acute ischemic stroke. All participants were pre-screened to ensure that they exhibited immediate responses to acupuncture. We used a twirling reinforcing acupuncture manipulation at the specific lines between the bilateral Baihui（GV20） and Taiyang（EX-HN5）. We collected neurologic deficit score, simplified Fugl-Meyer assessment score, muscle strength of the proximal and distal hemiplegic limbs, ratio of the maximal H-reflex to the maximal M-wave（Hmax/Mmax）, muscle tension at baseline and immediately after treatment, and the syndromes of traditional Chinese medicine at baseline. We then conducted data mining using an association algorithm and an artificial neural network backpropagation algorithm. We found that the twirling reinforcing manipulation had no obvious therapeutic difference in traditional Chinese medicine syndromes of ＂Deficiency and Excess＂. The change in the muscle strength of the upper distal and lower proximal limbs was one of the main factors affecting the immediate change in Fugl-Meyer scores. Additionally, we found a positive correlation between the muscle tension change of the upper limb and Hmax/Mmax immediate change, and both positive and negative correlations existed between the muscle tension change of the lower limb and immediate Hmax/Mmax change. Additionally, when the difference value of muscle tension for the upper and lower limbs was 〉 0 or 〈 0, the difference value of Hmax/Mmax was correspondingly positive or negative, indicating the scalp acupuncture has a bidirectional effect on muscle tension in hemiplegic limbs. Therefore, acupuncture with twirling reinforcing manipulation has distinct effects on acute ischemic stroke patients with different symptoms or stages of disease. Improved muscle tension in the upper and lower limbs, reflected by the variation in the Hmax/Mmax ratio, is crucial for recovery of motor function from hemiplegia.

Arsenic Accumulation in Rice:Sources,Human Health Impact and Probable Mitigation Approaches

The human body loading with arsenic(As)through rice consumption is a global health concern.There is a crucial need to limit As build-up in rice,either by remediating As accumulation in soils or reducing As levels in irrigation water.Several conventional approaches have been utilized to alleviate the As accumulation in rice.However,except for some irrigation practices,those approaches success and the adoption rate are not remarkable.This review presents human health risks posed due to consumption of As contaminated rice,evaluates different biomarkers for tracing As loading in the human body,and discusses the latest advancement in As reducing technologies emphasizing the application of seed priming,nanotechnology,and biochar application for limiting As loading in rice grains.We also evaluate different irrigation techniques to reduce As accumulation in rice.Altering water management regimes significantly reduces grain As accumulation.Bio-and nano-priming of rice seeds improve germination and minimize As translocation in rice tissues by protecting cell membrane,building pool around seed coat,methylation and volatilization,or quenching harmful effects of reactive oxygen species.Nanoparticle application in the form of nano-adsorbents or nano-fertilizers facilitates nano-remediation of As through the formation of Fe plaque or sorption or oxidation process.Incorporating biochar in the rice fields significantly reduces As through immobilization,physical adsorption,or surface complexation.In conclusion,As content in cooked rice depends on irrigation source and raw rice As level.

Angiosarcoma of the scalp diagnosed by the presence of neck inflammation:a case report

Angiosarcoma is an uncommon malignancy, which spread out from the endothelial cells of vessels. Scalp angiosarcoma with cervical lymph node metastasis is particularly rare. This article describes a rare case of angiosarcoma of the scalp, presenting as neck inflammation. Imaging procedures such as computed tomography （CT）, magnetic resonance image （MRI） and ultrasonography （US） were not sufficient to diagnose this case. A needle biopsy provided an effective and accurate diagnosis of cervical lymph node metastasis. Additional observation and physical examination was required to diagnose the origin of the primary cancerous lesion. Once the angiosarcoma diagnosis was confirmed histologically, sequential weekly and monthly docetaxel （DTX） treatment was effective in preventing reoccurrence. Nonetheless, the optimization of angiosarcoma treatment remains a future goal. Although patients generally describe pain and swelling at the primary lesion site, this patient complained only of painful neck inflammation, without any indication of pain or swelling of the scalp. A revised diagnostic protocol should note that cervical lymph node metastasis of unknown primary origin may result from angiosarcoma of the scalp.