Occipitofrontalis Muscle Tumors

The occipitofrontalis muscle (also called the epicranius) is a thin, wide muscle that spans the top of your head. Tumors can sometimes develop within or around this muscle, causing lumps, pain, or changes in scalp movement. Although rare, understanding these tumors—how they form, how they’re found, and how they’re treated—helps patients get the right care quickly.

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Anatomy of the Occipitofrontalis Muscle

Structure & Location

The occipitofrontalis has two broad “bellies” joined by a flat tendon (the epicranial aponeurosis).

• Frontal belly: sits just above your eyebrows.

• Occipital belly: lies near the back of the skull Wikipedia.

Origin & Insertion

• Occipital belly

  • Origin: lateral two-thirds of the superior nuchal line of the occipital bone and mastoid process of the temporal bone Kenhub.

  • Insertion: epicranial aponeurosis (the flat tendon running across the skull).

• Frontal belly

  • Origin: epicranial aponeurosis.

  • Insertion: skin of the forehead, eyebrows, and root of the nose Wikipedia.

Blood Supply

• Frontal belly: supraorbital and supratrochlear arteries (branches of the ophthalmic artery) Wikipedia.

• Occipital belly: occipital artery and posterior auricular artery (branches of the external carotid) Home.

Nerve Supply

Both bellies are moved by the facial nerve (cranial nerve VII):

• Frontal belly: temporal branch of CN VII.

• Occipital belly: posterior auricular branch of CN VII Kenhub.

Functions

1. Raises eyebrows — helps you look surprised or curious Wikipedia.

2. Wrinkles forehead skin — deepens horizontal lines across your brow.

3. Retracts (pulls back) scalp — works with occipital belly to shift scalp.

4. Assists scalp tension — helps keep the scalp snug over the skull.

5. Facilitates facial expression — important for nonverbal cues like astonishment.

6. Protects skull — tensioning the epicranial aponeurosis may cushion blows.

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Types of Occipitofrontalis Muscle Tumors

Benign Tumors

1. Intramuscular Lipoma: a slow-growing fatty lump inside the muscle.

2. Hemangioma: a mass of blood vessels that can swell and pulsate.

3. Lymphangioma: a fluid-filled (lymph) cystic growth.

4. Neurofibroma: arising from nerve sheath cells within the muscle.

5. Rhabdomyoma: rare, benign skeletal-muscle tumor.

Malignant Tumors

1. Rhabdomyosarcoma (RMS): cancer of immature muscle cells; most common in children (40% in head and neck) PMCWikipedia.

2. Leiomyosarcoma: arises from smooth-muscle fibers, rare in skeletal muscle.

3. Angiosarcoma: aggressive blood-vessel cancer; has been reported in the epicranius PMC.

4. Undifferentiated Pleomorphic Sarcoma: formerly “malignant fibrous histiocytoma,” a high-grade soft tissue sarcoma.

5. Metastatic Carcinoma: spread of skin or other cancers into the muscle.

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Causes

1. Spontaneous genetic mutation: random DNA errors during cell division NCBI.

2. Li-Fraumeni syndrome: inherited TP53 mutation raising sarcoma risk NCBI.

3. Neurofibromatosis type 1: predisposes to nerve-sheath tumors.

4. Radiation exposure: prior radiotherapy to the scalp area.

5. Chemical carcinogens: vinyl chloride, arsenic, dioxins.

6. Chronic lymphedema: long-term swelling (Stewart–Treves syndrome).

7. Chronic inflammation: from scarring or infection.

8. Viral infection: HHV-8 (Kaposi sarcoma) or possibly EBV.

9. Immunosuppression: e.g. post-transplant patients.

10. Family history of sarcomas.

11. Age extremes: pediatric rhabdomyosarcoma; adult leiomyosarcoma.

12. Trauma: repeated injury to the scalp/muscle.

13. Obesity: alters hormone and growth-factor levels.

14. Hormonal factors: unclear but may influence smooth muscle tumors.

15. Metabolic disorders: diabetes mellitus altering repair pathways.

16. UV radiation: sun exposure causing skin tumors that invade muscle.

17. Tuberous sclerosis: tuberous myomas can involve muscle.

18. Costello syndrome: rare RASopathy with tumor risk.

19. Beckwith-Wiedemann syndrome: overgrowth predisposition.

20. Environmental pollutants: pesticides, herbicides with mutagens.

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Symptoms

1. Painless lump on the forehead or scalp.

2. Slowly growing swelling that you can feel.

3. Pain or tenderness, especially with movement.

4. Reduced ability to raise eyebrows on that side.

5. Forehead wrinkles that look uneven.

6. Visible pulsation (vascular tumors).

7. Red or bluish skin, if superficial.

8. Scalp tightness or discomfort.

9. Headache over the involved area.

10. Numbness or tingling, if nerves are pressed.

11. Ulceration or skin breakdown over the tumor.

12. Bleeding from the lump.

13. Hair loss around the mass.

14. Fever or night sweats, with aggressive tumors.

15. Unintended weight loss, systemic sign of malignancy.

16. Fatigue, generalized from cancer.

17. Visual changes, if it invades near the brow ridge.

18. Facial asymmetry from muscle weakness.

19. Lymph node swelling in head/neck.

20. Difficulty wearing hats or glasses due to the bump.

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Diagnostic Tests

1. Physical exam: size, texture, mobility.

2. Ultrasound: distinguishes solid vs. fluid.

3. Color Doppler ultrasound: checks blood flow in vascular tumors.

4. CT scan: maps bone involvement and calcifications.

5. MRI: best for soft tissue definition and extent.

6. PET-CT: looks for spread to other sites.

7. Fine-needle aspiration biopsy: quick cell sample.

8. Core needle biopsy: larger tissue sample for histology.

9. Open incisional biopsy: direct view for tricky masses.

10. Histopathology: examines tumor cell types.

11. Immunohistochemistry: stains for muscle markers (desmin, myogenin).

12. Cytogenetic analysis: looks for gene fusions (e.g. PAX3-FOXO1).

13. Complete blood count: checks for anemia or high white cells.

14. LDH level: nonspecific tumor marker.

15. Creatine kinase (CK): muscle injury indicator.

16. Coagulation panel: before biopsy or surgery.

17. EMG (electromyography): assesses muscle function.

18. Angiography: plans surgery for vascular tumors.

19. Bone scan: rules out bone metastases.

20. Lymph node ultrasound/biopsy: checks regional spread.

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Non-Pharmacological Treatments

1. Surgical excision (see “Surgeries” below).

2. Radiation therapy (external beam).

3. Brachytherapy (radioactive seeds implanted).

4. Proton-beam therapy for precise dosing.

5. Stereotactic radiotherapy (focused beams).

6. Cryotherapy (freezing small, benign tumors).

7. Laser ablation for superficial lesions.

8. Physical therapy to preserve scalp mobility.

9. Occupational therapy for daily-living aids.

10. Massage therapy for pain relief.

11. Acupuncture for scalp discomfort.

12. Transcutaneous electrical nerve stimulation (TENS).

13. Hyperthermia therapy (heat to weaken tumor).

14. Photodynamic therapy (light-activated drugs).

15. Ultrasound therapy for pain and swelling.

16. Compression bandaging to reduce edema.

17. Wound care for ulcerated tumors.

18. Scalp dressings to protect open areas.

19. Hair-loss counseling for chemotherapy side effects.

20. Nutritional support to maintain strength.

21. Yoga and relaxation to reduce stress.

22. Mindfulness meditation for coping.

23. Psychological counseling for emotional support.

24. Support groups for patients/families.

25. Protective headgear to avoid trauma.

26. Sun protection (hats, sunscreen) over scars.

27. Scalp hygiene to prevent infection.

28. Low-level laser therapy for wound healing.

29. Cryolipolysis (fat freezing) for lipomas.

30. Electrochemotherapy (electric pulses + chemo dye).

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Drugs

1. Doxorubicin – main chemo for sarcoma NCBI.

2. Ifosfamide – often paired with doxorubicin.

3. Vincristine – part of RMS regimens.

4. Actinomycin D – used in pediatric RMS.

5. Cyclophosphamide – alkylating agent.

6. Etoposide – topo II inhibitor for sarcomas.

7. Irinotecan – sometimes for RMS relapse.

8. Pazopanib – targeted therapy for STS PMC.

9. Imatinib – for PDGFR-driven tumors.

10. Bevacizumab – anti-VEGF for angiosarcoma.

11. Prednisone – steroid for inflammation.

12. Dexamethasone – high-potency steroid.

13. Ibuprofen – NSAID for mild pain.

14. Naproxen – longer-acting NSAID.

15. Morphine – strong opioid for severe pain.

16. Tramadol – moderate opioid.

17. Gabapentin – nerve-pain agent.

18. Ondansetron – anti-nausea during chemo.

19. Zolendronic acid – bone pain/spread prevention.

20. Pembrolizumab – immunotherapy for advanced STS.

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Surgeries

1. Wide local excision – remove tumor + margin.

2. En bloc resection – remove tumor in one piece.

3. Mohs micrographic surgery – layer-by-layer removal for skin cancers invading muscle.

4. Radical resection with flap reconstruction – for large defects.

5. Debulking surgery – shrink tumor when cure isn’t possible.

6. Nerve-sparing resection – preserve facial nerve function.

7. Lymph node dissection – if nodes are involved.

8. Endoscopic resection – minimally invasive for small lesions.

9. Cryosurgical removal – freeze and remove small tumors.

10. Scalp rotation flap – cover defects after excision.

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Preventions

1. Limit scalp radiation when possible.

2. Sun protection (broad-spectrum SPF 30+).

3. Avoid known carcinogens (arsenic, dioxins).

4. Protective headgear in high-risk jobs.

5. Genetic counseling if family history of sarcoma.

6. Regular scalp self-exams for new lumps.

7. Healthy diet & exercise to boost immunity.

8. Control chronic conditions (diabetes, lymphedema).

9. Avoid smoking and second-hand smoke.

10. Promptly treat chronic scalp infections or wounds.

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When to See a Doctor

• Any new scalp lump lasting > 2 weeks

• Rapid growth or change in color

• Persistent pain or tenderness

• Skin ulceration or bleeding

• Numbness/weakness of forehead movement

• Fever, night sweats, or weight loss

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Frequently Asked Questions

1. What is an occipitofrontalis muscle tumor?
   A growth—benign or malignant—arising within the muscle that moves your scalp Wikipedia.

2. How common are these tumors?
   Extremely rare; muscle tumors account for < 1% of all soft-tissue sarcomas PubMed.

3. Can they be benign?
   Yes, many are harmless lipomas or hemangiomas.

4. What causes them?
   Often unknown; risk factors include genetic syndromes, radiation, and toxins.

5. How are they diagnosed?
   Through imaging (MRI, ultrasound) and biopsy.

6. Can they spread?
   Malignant types (e.g., rhabdomyosarcoma) can metastasize via blood or lymph PMC.

7. What are main treatments?
   Surgery, radiation, and chemotherapy tailored to tumor type.

8. Is surgery always needed?
   For benign, small tumors you might observe or use cryotherapy; malignant usually require excision.

9. What side effects should I expect?
   Depends on treatment: pain, hair loss, weakness, fatigue.

10. Can they recur?
    Yes—especially high-grade sarcomas require close follow-up.

11. What is the prognosis?
    Benign tumors: excellent. Malignant: 5-year survival 60–70% for localized sarcoma PMC.

12. Who treats these tumors?
    A team: surgical oncologist, radiation oncologist, medical oncologist, and physical therapist.

13. How long is recovery?
    From weeks (minor excision) to months (radical surgery + chemo).

14. Can I prevent them?
    Not entirely, but avoid radiation and carcinogens, and do self-checks.

15. When should I get a second opinion?
    For any malignant diagnosis, or if treatment risks are high.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

Last Updated: April 27, 2025.

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