Aggressive Squamous Carcinomas of the Scalp

Authors: LANG, PEARON G.1; BRAUN, MARTIN A.1; KWATRA, RAJIV1

Source: Dermatologic Surgery, Volume 32, Number 9, September 2006 , pp. 1163-1170(8)

Publisher: Blackwell Publishing

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Abstract:

BACKGROUND

Squamous cell carcinomas of the scalp sometimes exhibit unusually aggressive behavior. OBJECTIVE

To describe a series of 11 cases of extraordinarily aggressive squamous cell carcinomas of the scalp. METHODS

These cases were selected based on a number of criteria including their tendency to recur after Mohs surgery, their propensity to develop satellite lesions, their tendency to invade bone, and their tendency to metastasize to regional nodes and systemically. A chart review was performed for each patient. RESULTS

Five of 11 patients have succumbed to their disease. Of note is that the patients all had significant long-standing alopecia or thinning of their hair with marked actinic damage. Initial biopsies of the tumors revealed them to be either moderate or well-differentiated. Four of 11 patients developed satellite lesions and experienced recurrences despite obtaining clear margins with Mohs micrographic surgery. CONCLUSION

Squamous cell carcinomas of the scalp may metastasize and cause death. Thus, early diagnosis and treatment of these neoplasms is mandatory. In the setting of satellitosis, it is believed that it is best to perform a wide excision with margin control followed by split-thickness grafting and postoperative irradiation. The employment of radiation therapy, however, should be done with appropriate caution owing to the significant risk of osteoradionecrosis.

Pearon G. Lang Jr., MD, Martin A. Braun, MD, and Rajiv Kwatra, MD, have indicated no significant interest with commercial supporters.

Document Type: Research article

DOI: 10.1111/j.1524-4725.2006.32258.x

Affiliations: 1: All authors are affiliated with the Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina

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