Anatomical restrictions in the surgical excision of scalp squamous cell carcinomas: does this affect local recurrence and regional nodal metastases?

Jenkins, G.; Kanatas, Anastasios; Smith, Adam B.; Telfer, M.R.

doi:10.1016/j.bjoms.2012.04.187

Cited by 3 publications

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“…This question is amplified in the literature as a frequent complication of these cases is inadequate and incomplete resection at the deep margin. 9,17 Moreover, both cases of recurrence in our study occurred at the deep margin. We believe the data in this study supports our current approach in our practice of proceeding with burring of the outer table sans frank calvarial invasion.…”

Section: Discussionmentioning

confidence: 49%

“…16,19 Only 1 of these studies noted recurrence rates in their patients but did not explicitly analyze the oncologic management of their patients. 17 Kadakia et al 20 discussed their algorithm for outer table resection versus full thickness craniectomy. However, the patients in this study were a unique population as all were transplant patients on immunosup-pressive drugs.…”

Section: Discussionmentioning

confidence: 99%

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The Role of Resection of the Outer Table of the Cranium in Locally Invasive Primary Squamous Cell Carcinoma of the Scalp

Leach

Pflibsen

Mathew

et al. 2022

Journal of Craniofacial Surgery

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Introduction: Nonmelanoma skin cancer is the most common malignancy of the scalp. Of these, squamous cell carcinoma (SCC) is the most troublesome. It poses a challenge to the surgeons caring for these patients as the anatomy of the scalp makes excision and reconstruction difficult. Although more superficial lesions are amenable to Mohs micrographic surgery, more invasive lesions require a different approach. This manuscript is a retrospective review of outer table resection for SCC of the scalp invading to the depth of the pericranium. We include a discussion of full thickness craniectomy for invasive SCC, regardless of depth of invasion, for completeness. Methods: IRB approval was obtained from St. Joseph’s Hospital and Medical Center in Phoenix, Arizona. One hundred four potential cases identified based on ICD codes. Ultimately, 23 cases met study criteria and were included in this analysis. Seventeen cases of outer table resection and 6 cases of full craniectomy were discussed. Additionally, the authors’ approach for resection and reconstruction is articulated. Results: Seventeen patients underwent outer table resection at an average age of 79.3 years. All had invasion of the pericranium with a mean surface area of 42.6 cm2. Eight patients had prior radiation treatment for SCC of the scalp and 12 patients had at least 1 prior surgery to attempt excision of their lesions. Two patients had local recurrence for a local control rate of 88.2% (15/17). One patient with metastasis prior to presentation, died 6 months after his initial surgery for disease-free survival rate of 94.1% (16/17) at a mean of 15.4months. Thirteen patients were able to achieve immediate reconstruction with local flaps with or without additional skin grafting (76.5%). Discussion: The data in this study supports that in instances of locally invasive primary SCC of the scalp that extends to the pericranium, excision down to the calvarium with complete circumferential and deep peripheral margin assessment, followed by resection of the outer table, is an excellent option. The low rate of local recurrence and high disease-free survival in this study support that this method allows for optimal oncologic outcome while mitigating the significant morbidity associated with the alternative option of a full thickness craniectomy.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

The Role of Resection of the Outer Table of the Cranium in Locally Invasive Primary Squamous Cell Carcinoma of the Scalp

Leach

Pflibsen

Mathew

et al. 2022

Journal of Craniofacial Surgery

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“…En cuanto a la recidiva de la enfermedad, un estudio realizado entre 1997-2009 en la Universidad de Calgary en Canadá, reportó tasas de recurrencia pese al tratamiento de 3,8% ( 14) Otro trabajo realizado en Inglaterra demostró una tasa de recurrencia local del 6% y una tasa de metástasis de un 7%, y todos los pacientes que presentaron recurrencia de la enfermedad, lo hicieron dentro de los 18 meses de la cirugía primaria (33). Lastimosamente, la paciente se encontró dentro del pequeño porcentaje de individuos que presenta recurrencia.…”

Section: Discussionunclassified

Carcinoma epidermoide cutáneo invasivo a cráneo. Reporte de un caso

Páez

Hinojosa²,

Jaramillo

et al. 2014

Rev. Med.

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<div class="page" title="Page 1"><div class="layoutArea"><div class="column"><p><span>Dentro del grupo de cáncer cutáneo no melanoma (CCNM), el Carcinoma cutáneo de células es- camosas (CE) representa el 25% siendo el segundo más frecuente, con una incidencia a lo largo de la vida del 7 y 11%. El Carcinoma Epidermoide (CE) es más agresivo que el Carcinoma basocelular (CBC). También pueden invadir estructuras profundas, causando significativa destrucción local. Presentamos el caso clínico de una mujer de 71 años que había sido previamente intervenida por diagnóstico anatomopatológico de carcinoma epidermoide de cuero cabelludo moderadamente diferenciado. Posteriormente presentó amplia recidiva local en zona frontal con invasión de diploe craneal y espacio epidural. Fue intervenida quirúrgicamente y el defecto secundario se reparó con colgajo e injertos. La biopsia confirmó bordes libres. Sin embargo un mes después, la paciente presentó invasión del cáncer a techo de la órbita. Se describe el tratamiento quirúrgico realizado por los servicios de Cirugía Plástica y Neurocirugía. Se reporta este caso clínico, ya que la incidencia de cáncer en la piel ha aumentado en los últimos años, por las mayores áreas expuestas al sol y mayor longevidad. Sin embargo su evolución es detenida la mayoría de las veces con un diagnóstico y tratamiento oportuno, aspectos con los que no contó la paciente, terminando en una excepcional invasión intracraneal, implicación poco frecuente en la práctica clínica. </span></p></div></div></div>

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Incomplete surgical excision of keratinocyte skin cancers: a systematic review and meta‐analysis*

et al. 2020

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Summary Background Keratinocyte or nonmelanoma skin cancer (NMSC) is the commonest malignancy worldwide. The usual treatment is surgical excision. Current guidelines underestimate incomplete excision rates. Objectives We aimed to determine the risk of incomplete excision of NMSCs through a systematic review and meta‐analysis of primary clinical studies. Methods A PRISMA‐compliant systematic review and meta‐analysis was performed using methodology proposed by Cochrane (PROSPERO CRD42019157936). A comprehensive search strategy was applied to MEDLINE, Embase, Scopus, CINAHL, EMCare, Cochrane Library and the grey literature (January 2000–27 November 2019). All studies were included except those on Mohs micrographic surgery, frozen section or biopsies. Abstract screening and data extraction were performed in duplicate. Risk of bias was assessed using a tool for prevalence/incidence studies. The primary outcome was the proportion of incomplete surgical excisions. A random‐effects model for pooling of binomial data was used. Differences between proportions were assessed by subgroup meta‐analysis and meta‐regression, which were presented as risk ratios (RRs). Results Searching identified 3477 records, with 110 studies included, comprising 53 796 patients with 106 832 basal cell carcinomas (BCCs) and 21 569 squamous cell carcinomas (SCCs). The proportion of incomplete excisions for BCC was 11·0% [95% confidence interval (CI) 9·7–12·4] and for SCC 9·4% (95% CI 7·6–11·4). Proportions of incomplete excisions by specialty were: dermatology, BCCs 6·2% and SCCs 4·7%; plastic surgery, BCCs 9·4% and SCCs 8·2%; general practitioners, BCCs 20·4% and SCCs 18·9%. The risk of incomplete excision for general practitioners was four times that of dermatologists for both BCCs (RR 3·9, 95% CI 2·0–7·3) and SCCs (RR 4·8, 95% CI 1·0–22·8). Studies were heterogeneous (I2 = 98%) and at high risk of bias. Conclusions The proportion of incomplete excisions is higher than previously reported. Excisions performed by specialists may lower the risk of incomplete excision.

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Anatomical restrictions in the surgical excision of scalp squamous cell carcinomas: does this affect local recurrence and regional nodal metastases?

Cited by 3 publications

References 0 publications

The Role of Resection of the Outer Table of the Cranium in Locally Invasive Primary Squamous Cell Carcinoma of the Scalp

The Role of Resection of the Outer Table of the Cranium in Locally Invasive Primary Squamous Cell Carcinoma of the Scalp

Carcinoma epidermoide cutáneo invasivo a cráneo. Reporte de un caso

Incomplete surgical excision of keratinocyte skin cancers: a systematic review and meta‐analysis*

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