Locally Advanced Scalp Tumors

Abstract

Introduction Locally advanced nonmelanoma skin cancers of the head and neck are well described in the current literature. However, data about clinical and survival outcomes are lacking. We present survival data from a tertiary head and neck cancer unit in London. Methods A retrospective analysis of data collected from a single institution was conducted. All patients with locally advanced cutaneous scalp carcinomas invading the skull between 2011 and 2019 were included. Data included patient demographics, tumor, comorbidities, interventions, flap survival, and metal work exposure. Survival outcomes were examined using Kaplan-Meier analysis. Results Twenty-three patients were identified. The mean age was 72 years. Eighteen patients were male, and 5 were female. Five patients were immunosuppressed. Nineteen patients underwent outer cortex drill-down/full-thickness calvarial resection, followed by reconstruction with free tissue transfer. Six patients had titanium mesh reconstruction after segmental skull resections. Three patients underwent further surgery because of exposed metalwork. Disease-free survival at 3 years after surgery was 60%. Conclusions Locally advanced nonmelanoma skin cancers invading the bone are sporadic. There are little published data on clinical and survival outcomes in this group. Despite the nature of these skin lesions, a high degree of local control can be obtained by extensive surgical resection, outer table drill-down, and calvarial resection. We conclude that aggressive management of the bony invasion improves disease-free survival and improves local control.

The Utility of Bone Burring for the Clearance of Locally Advanced Scalp Malignancies: A Scoping Review

“…The local control rates as attributable to burring ranged from 50% to 100% among the studies. The outcome, disease-related mortality, was extrapolated from data reported by Leach et al 10 and Ziegler et al 16 A pertinent secondary outcome was reported in only one study (Sleiwah et al 17 ) with one patient developing an infection. The majority of the included studies reported reconstructive details of their cases, but this aspect is outside the scope of this study.…”

“…14,15,17,22 This is in contrast to the reconstruction of full-thickness craniectomies, which almost always require cranioplasty for the skull defect and free flaps for coverage. 17,21,34…”

“…( See table, Supplemental Digital Content 1, http://links.lww.com/PRSGO/C721.) Although some studies reported complications regarding reconstruction, the study by Sleiwah et al 17 was the only article reporting a complication attributable to burring: one patient had an infection. Although this may be a testament to the skill of the surgeons operating, it is not possible to exclude reporting bias.…”

“…The conducted search identified eight relevant studies in the form of case reports and case series. Several articles [14][15][16][17][18][19][20][21] detailing the clinical management and outcomes of patients with scalp malignancy mention the use of bone burring but provide no explanation as to why this technique was implemented in these cases over alternatives such as outer table splitting, 10,21,22 outer table curettage, 23 or high-dose radiotherapy as a sole treatment. 24,25 It was determined that a scoping review would be more appropriate than a systematic review for this research question due to the anticipated heterogeneity and low evidence level of the available studies on this topic.…”

“…Malignant scalp neoplasms that invade the calvarial bone routinely involve full-thickness craniectomy during their resection. 17,21,34 Outer table resection procedures can be upgraded to full-thickness craniectomy in the case of positive frozen section analysis of the outer cortex, which signifies bony tumor involvement. 21…”