Resection Deep Invasion of Scalp Carcinoma Using Skull Base Techniques

Abstract

Skin cancer involving the scalp is a common malignancy in the sunbelt areas of the United States. Most early lesions are well managed by primary care physicians and dermatologists. Occasionally, we encounter basal cell, squamous cell, and, rarely, Merkel cell carcinomas that have failed local therapy and present with large tumors invading the full thickness scalp, calvarium, and occasionally the underlying brain. We describe our experience with 12 such tumors and illustrate their resections and reconstruction. For full thickness lesions, we generally do a wide field resection of the skull and underlying calvarium followed by dural resection and that of the underlying brain, if affected in ineloquent regions. Reconstruction is usually with dural replacement, calvarial reconstruction with titanium mesh, and cutaneous reconstruction with a musculocutaneous free flap or muscular free flap with an overlying skin graft. Complications, survival rates, and recurrence rates will be presented.