Custom surgical management of invasive malignant tumors of the scalp

Marijon, Pauline; Bertolus, Chloé; Foy, Jean‐Philippe; Marechal, G.; Caruhel, Jean-Baptiste; Benassarou, Mourad; Carpentier, Alexandre; Degos, Vincent; Amelot, Aymeric; Mathon, Bertrand

doi:10.1007/s00701-020-04525-0

Cited by 5 publications

(5 citation statements)

References 24 publications

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“…In summary, by reducing the risk of thermal and physical damage, piezoelectric saws help improve surgical outcomes and patient recovery [ 29 ]. Craniectomy and dura mater excision lead to the creation of a complex wound that exposes the patient to the risk of cerebrospinal fluid leak and infection; after these procedures, there is no agreement about the indication of cranioplasty for cerebral protection and maintaining the contour of the calvarium [ 30 ]. Performing a cranioplasty in the immediate reconstruction remains a controversial point because, as reported by several studies [ 31 , 32 ], the risk of postoperative infections—which, in most cases, require the removal of the implant—is considerably higher; for these reasons, our team’s preference is not to perform it.…”

Section: Discussionmentioning

confidence: 99%

“…They provide a large amount of well-vascularized tissue that better contours to the calvaria’s convexity and supports eventual adjuvant radiotherapy with minimal soft-tissue complications. The free latissimus dorsi muscle transfer is nowadays considered the mainstay to cover complex scalp defects and tolerate radiation [ 30 ]. For our patient with extensive SCC of the parietomastoid area, we chose a latissimus dorsi free flap, benefiting from its constant and reliable pedicle and its capability to adhere better to the underlying surface without bulkiness, offering an excellent aesthetic appearance when covered with a split-thickness graft.…”

Section: Discussionmentioning

confidence: 99%

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Multidisciplinary Management of Cutaneous Squamous Cell Carcinoma of the Scalp: An Algorithm for Reconstruction and Treatment

Rodio,

Tettamanzi,

Trignano

et al. 2024

JCM

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Background: Scalp-associated cutaneous squamous cell carcinoma (cSCC) presents formidable treatment challenges, especially when it leads to full-thickness defects involving bone. Aggressive or recurring cases often demand a multidisciplinary approach. Leveraging our surgical experience and a literature review, we introduce a therapeutic algorithm to guide the selection of reconstruction methods, particularly for locally advanced lesions, furthermore showing the synergy between surgery and other therapies for comprehensive, multidisciplinary disease management. Methods: Our algorithm stems from a retrospective analysis of 202 patients undergoing scalp cSCC resection and reconstruction over a 7-year period, encompassing 243 malignancies. After rigorous risk assessment and documentation of surgical procedures, reconstruction methods were therefore related to malignancy extent, depth, and individual clinical status. Results: The documented reconstructions included 76 primary closures, 115 skin grafts, 7 dermal substitute reconstructions, 33 local flaps, 1 locoregional flap, and 1 microsurgical free flap. Patients unsuitable for surgery received radiotherapy or immunotherapy after histological confirmation. Precise analysis of tumor characteristics in terms of infiltration extent and depth guided the selection of appropriate reconstruction and treatment strategies Combining these insights with an extensive literature review enabled us to formulate our algorithm for managing scalp cSCCs. Conclusions: Effectively addressing scalp cSCC, especially in locally advanced or recurrent cases, demands a systematic approach integrating surgery, radiotherapy, and immunotherapy. Our multidisciplinary team’s decision-making algorithm improved patient outcomes by offering a broader spectrum of therapeutic options that can synergistically achieve optimal results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Multidisciplinary Management of Cutaneous Squamous Cell Carcinoma of the Scalp: An Algorithm for Reconstruction and Treatment

Rodio,

Tettamanzi,

Trignano

et al. 2024

JCM

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“…CFR is used only for specific types of tumors, making it difficult to generate prospective data on this topic from a large cohort (15). Therefore, information about which patients are more likely to have unfavorable outcomes is extremely valuable to guide future therapeutic decisions.…”

Section: ' Discussionmentioning

confidence: 99%

Short-term survival in extensive craniofacial resections

Leite

Alvarenga

Gonçalves

et al. 2021

Clinics

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Craniofacial resection (CFR) procedures for craniofacial tumors with cranial extension are often extensive. Although CFRs may yield good oncological results, there are concerns about high perioperative morbidity and mortality. This study aimed to determine risk factors for perioperative mortality after open CFR in terms of deaths occurring during index hospitalizations. METHODS: We conducted a retrospective analysis of CFRs conducted at a tertiary oncology hospital from May 2009 through December 2018. RESULTS: Our analysis included data from the medical records of 102 patients, the majority of whom were male (n=74, 72.5%). The mean age was 61 years ( ± 18.3 years). Skin malignancies (n=64, 63.4%) accounted for nearly two-thirds of the treated tumors, and most of these were squamous cell carcinoma. Postoperative medical complications occurred in 33 patients (33%), and surgical complications occurred in 48 (47%). Multivariate analysis revealed the only independent risk factors for perioperative deaths to be the presence of intracranial tumor extension on preoperative imaging (hazard ratio [HR]=4.56; 95% confidence interval [CI]: 1.74-11.97; p=0.002) and the unexpected emergence of postoperative neurological dysfunction (HR=10.9; 95% CI: 2.21-54.3; p=0.003). CONCLUSIONS: In our study, factors related to tumor extension were associated with a higher risk of perioperative death.

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“…The extensive scalp defects can be reconstructed using large local scalp flap transposition ( 16 , 17 ). Wide resection with craniectomy and reconstruction with microvascular free tissue transfer provides safe and reliable treatment of recalcitrant invasive scalp skin cancers ( 18 ). The role of radiation therapy and systemic chemotherapy after surgery is not clear in the extraocular SC, which are only suggested for patients who are poor surgical candidates or those with recurrent or metastatic disease ( 12 , 13 , 19 ).…”

Section: Discussionmentioning

confidence: 99%

Aggressive sebaceous carcinoma of the scalp: a case report and literature review

Li¹,

Shen²,

Huang³

et al. 2021

Transl Cancer Res TCR

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Sebaceous carcinoma (SC) is an uncommon and potentially aggressive adnexal neoplasm. SC presents most often as a periocular tumor arising from the ocular adnexa with unclear pathogenesis.Aggressive SC of the scalp is extremely rare. Here, we describe a rare case of aggressive SC of the scalp in a 61-year-old female, who presented with a scalp neoplasm lasting for two months. Cranial magnetic resonance imaging (MRI) revealed a partly necrotic and cystic tumor with mixed signal shadow. The parietal multiple destructive lesions invaded the skull, involved the dura mater, and compressed the associated superior sagittal sinus. A wide local lesion excision with Ⅰ stage repair of dura mater and Ⅰ stage bone graft of skull was performed in our department. The patient was treated with external radiation to prevent recurrence and was followed for 3 years with favorable results. The relevant literature regarding aggressive SC was reviewed, and the clinical manifestations, radiological characteristics, surgical strategies, histopathological findings, and prognosis are discussed. This cutaneous malignancy invaded skull, dura mater or brain, or metastasized to the lymph nodes and viscera, with high recurrence and fatality rates. It is necessary to be aware of these rare examples which showed unexpectedly clinical behaviors. Early precise diagnosis and improved radical treatment remain essential steps against aggressive cutaneous malignancy. Patients with aggressive SC of the scalp should be closely followed to assess recurrence and distant metastasis.

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Custom surgical management of invasive malignant tumors of the scalp

Abstract: Short running head: Surgery of invasive cancers of the scalp

Cited by 5 publications

References 24 publications

Multidisciplinary Management of Cutaneous Squamous Cell Carcinoma of the Scalp: An Algorithm for Reconstruction and Treatment

Multidisciplinary Management of Cutaneous Squamous Cell Carcinoma of the Scalp: An Algorithm for Reconstruction and Treatment

Short-term survival in extensive craniofacial resections

Aggressive sebaceous carcinoma of the scalp: a case report and literature review

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