Surgical Reconstruction of a Large Defect after Excision of Infiltrative Squamous Cell Carcinoma in the Scalp and Occipital Region: A Case Report

Abstract

Squamous cell carcinoma (SCC) of the scalp is the second most prevalent skin cancer, following basal cell carcinoma. Notably, it has the capability to infiltrate the skull, dura mater, and even brain tissue. The cornerstone of treatment is the surgical removal of the lesion, with a particular focus on the depth of invasion, which is directly correlated with recurrence rates. Post-surgical strategies may involve immediate or delayed cranial bone reconstruction and repair of scalp defects using either artificial dermis or skin grafts. In the case presented, a substantial defect necessitated more than a single flap for primary repair. Hence, a single pedicle double-island flap was designed for reconstructing the occipital area. Due to increased tension on the flap following cranial bone repair, the bone repair was temporarily deferred. Postoperative care included adjuvant chemotherapy and radiotherapy to mitigate the risk of SCC recurrence.