Oncologic Outcomes of Invasive Squamous Cell Carcinoma of the Scalp Requiring Resection of Cranial Bone

Abstract

Objectives To identify the recurrence rates and survival outcomes of patients with invasive squamous cell carcinoma of the scalp.

Methods This study was a retrospective chart review of eight patients that had squamous cell carcinoma of the scalp with either periosteal or skull invasion on clinical and/or radiographic evaluation.

Results The disease-free survival was 62.5% (5/8 patients) with a local control rate of 75% (6/8 patients) for the entire group. The two patients with full-thickness craniectomy had a local control rate of 100% (2/2 patients); the patients with outer cortex removal had a local control rate of 66.7% (4/6 patients). The disease-free survival of the full-thickness group was 50% (1/2 patients ), and the disease-free survival of the outer cortex removal patients was 66.7% (4/6 patients).

Conclusion Despite the invasive nature of this disease, a high degree of local control can be achieved in this high-risk group with multiple comorbidities using outer cortex drilldown, and, in properly selected patients, full-thickness calvarial resection. We conclude that for patients without evidence of medullary involvement that outer table drilldown offers a well-tolerated approach with reasonable oncologic control.

Keywords

squamous cell carcinoma - scalp cancer - head and neck cancer - survival outcomes - periosteal invasion

• References

• 1 Akcam TM, Gubisch W, Unlu H. Nonmelanoma skin cancer of the head and neck: surgical treatment. Facial Plast Surg Clin North Am 2012; 20 (4) 455-471
• 2 Karia PS, Han J, Schmults CD. Cutaneous squamous cell carcinoma: estimated incidence of disease, nodal metastasis, and deaths from disease in the United States, 2012. J Am Acad Dermatol 2013; 68 (6) 957-966
• 3 Donald PJ, Boggan J, Farwell DG, Enepekides DJ. Skull base surgery for the management of deeply invasive scalp cancer. Skull Base 2011; 21 (6) 343-350
• 4 Brougham ND, Dennett ER, Cameron R, Tan ST. The incidence of metastasis from cutaneous squamous cell carcinoma and the impact of its risk factors. J Surg Oncol 2012; 106 (7) 811-815
• 5 Mendenhall WM, Amdur RJ, Williams LS, Mancuso AA, Stringer SP, Price Mendenhall N. Carcinoma of the skin of the head and neck with perineural invasion. Head Neck 2002; 24 (1) 78-83
• 6 Solares CA, Lee K, Parmar P, O'Rourke P, Panizza B. Epidemiology of clinical perineural invasion in cutaneous squamous cell carcinoma of the head and neck. Otolaryngol Head Neck Surg 2012; 146 (5) 746-751
• 7 Aspoas AR, Wilson GR, McLean NR, Mendelow AD, Crawford PJ. Microvascular reconstruction of complex craniofacial defects. Ann R Coll Surg Engl 1997; 79 (4) 278-283
• 8 McCombe D, Donato R, Hofer SOP, Morrison W. Free flaps in the treatment of locally advanced malignancy of the scalp and forehead. Ann Plast Surg 2002; 48 (6) 600-606
• 9 Panizza B, Solares CA, Redmond M, Parmar P, O'Rourke P. Surgical resection for clinical perineural invasion from cutaneous squamous cell carcinoma of the head and neck. Head Neck 2012; 34 (11) 1622-1627
• 10 Rowe DE, Carroll RJ, Day Jr CL. Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip. Implications for treatment modality selection. J Am Acad Dermatol 1992; 26 (6) 976-990
• 11 Farasat S, Yu SS, Neel VA , et al. A new American Joint Committee on Cancer staging system for cutaneous squamous cell carcinoma: creation and rationale for inclusion of tumor (T) characteristics. J Am Acad Dermatol 2011; 64 (6) 1051-1059
• 12 Brantsch KD, Meisner C, Schönfisch B , et al. Analysis of risk factors determining prognosis of cutaneous squamous-cell carcinoma: a prospective study. Lancet Oncol 2008; 9 (8) 713-720
• 13 Chren MM, Linos E, Torres JS, Stuart SE, Parvataneni R, Boscardin WJ. Tumor recurrence 5 years after treatment of cutaneous basal cell carcinoma and squamous cell carcinoma. J Invest Dermatol 2013; 133 (5) 1188-1196
• 14 Abo Sedira M, Amin AA, Rifaat MA, El-Sebai HI, El-Badawy MA, Aboul Kassem HA. Locally advanced tumors of the scalp: the Egyptian National Cancer Institute experience. J Egypt Natl Canc Inst 2006; 18 (3) 250-257