Abstract
Objective
We analyzed outcomes from immunocompromised patients with scalp squamous cell carcinoma (SCC) treated with surgical excision with and without radiation in order to explore 3-year disease-free survival and overall survival.
Study design
The study design was a retrospective chart review.
Setting
This study was conducted in a private practice setting.
Subjects and methods
The study included 53 immunocompromised patients with an average age of 63.2 years, with scalp squamous cell carcinoma. Pre-operative imaging dictated the extent of resection. Patients with bony involvement received wide local excision including full-thickness craniectomy and cranioplasty. Patients without bony involvement underwent wide local excision and outer-table calvarial resection. All patients were recommended to have post-operative radiation. Patients were followed for a minimum of 3 years.
Results
A total of 53 patients were included in the study. Six patients had pre-operative CT showing bone involvement and were treated with full-thickness craniectomy along with post-operative radiation. Fourteen patients without bone involvement on pre-operative CT were found to have positive bone involvement on final pathology. Forty-five patients underwent post-operative radiation. Patients treated with adjuvant radiation demonstrated a 3-year survival of 80 % and the overall survival was 62 %. In the surgery-only group, the 3-year survival was 62.5 % and the overall survival was 32.5 %.
Conclusions
Immunocompromised patients with scalp SCC have a poor prognosis. Early detection and treatment are crucial. Based on our results, we recommend wide local excision with at least outer-table calvarial resection, and post-operative radiation. Despite aggressive therapy, patients may still have distant, local, or regional recurrence.
Level of evidence: level 2b (retrospective cohort)
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This study had IRB approval from John Peter Smith Hospital.
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The authors declare that they have no competing interests.
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Kadakia, S., Ducic, Y., Marra, D. et al. Cutaneous squamous cell carcinoma of the scalp in the immunocompromised patient: review of 53 cases. Oral Maxillofac Surg 20, 171–175 (2016). https://doi.org/10.1007/s10006-016-0545-6
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DOI: https://doi.org/10.1007/s10006-016-0545-6