The child with a mass on its head: diagnostic and surgical strategies

Abstract

A series of 65 pediatric patients with scalp or calvarial masses is reported on. The majority of children presented with a disfiguring or painful mass on the head. Clinical findings suggested the correct diagnosis in 39/65 cases, skull radiographs in 46/65, and CT in 49/65. Taking the combined results of clinical and radiological studies, 54/65 of the lesions were accurately diagnosed. Tumor excision was curative in 43 of 48 patients who were operated on. Most scalp and calvarial neoplasms were benign; only 5/65 children harboured a malignant lesion. There was no mortality related to surgery in the series. Surgical intervention seems to be indicated in most cases, both for diagnosis and for treatment.

A study of 77 cases of surgically excised scalp and skull masses in pediatric patients

“…This has been reported to comprise 7-10.8% of scalp masses in children [16,20], but we observed that it was the most common type of scalp lesion in our study, occurring in 16 of 75 cases (20.8%). Ninety percent of this condition occurs in children aged 5-15 patients as a tender mass [2,16,19,22]. The site of occurrence is irrespective of cranial sutures and usually does not penetrate the dura [20].…”

“…Late recurrent disease has been reported 10 years after initial therapy, and therefore, long-term follow-up is recommended. Solitary LCH lesions of the skull show a low incidence of recurrence (0-1.5%), but this may be as high as 31% in other reports [16,19]. We experienced one case (1 of 16) of recurrence in this study.…”

“…According to reports by Ruge et al [20] and Martinez-Lage et al [16], scalp and skull masses that occur in infants of less than 1 year of age are atretic cephaloceles, cephalohematoma, and dermoids, in descending order of frequency, while in 1-7 aged children, the order is dermoids, LCH, and malignant tumors, and in those aged more than 8 years, the order is fibrous dysplasia, dermoids, and osteomas.…”

“…The rate of pediatric scalp and skull masses with intracranial extension has been reported to be 37-57%, while the incidence of intradural extensions is reported to be a smaller 16% [16,20]. Taking into consideration previous reports that dermoid cysts comprise 15-58.5% of pediatric scalp and skull masses and that dermal sinus tracts are found in approximately half of these dermoid cyst patients, it may be that intradural extensions may be present in more than the above reported 16%.…”

“…Although 89% of lesions have shown to be diagnosed via neuroradiological studies, the less frequently occurring metastatic tumors or fasciitis, desmoplastic fibromas, fibromatosis, and ossifying fibromas are difficult to confirm without surgical intervention [20]. Furthermore, the possibility of the presence of malignant tumors, including metastatic tumors, has been shown to be from 0 to 25% in several different series, suggesting that pathologic confirmation is essential [6,16,20]. Many cases of pediatric scalp and skull masses are congenital or developmental tumors or diseases that may lead to intracranial extension, further emphasizing the need for pathologic conformation of disease after surgical removal, although the incidence of malignant conditions are not high.…”