European Journal of Plastic Surgery

, Volume 40, Issue 6, pp 573–578 | Cite as

Giant adenoid basal cell carcinoma of the scalp with intracranial involvement—successful management strategies for a rare entity

  • Mona Ascha
  • Amy Hiuser
  • Melissa Piliang
  • Graham S. SchwarzEmail author
Case Report


Adenoid basal cell carcinoma (BCC) is a rare but aggressive histologic subtype of BCC. The aim of this report is to present our multidisciplinary management strategy and a literature review on this seldom reported entity. A 72-year-old female with fungating giant BCC of the scalp, ear, and bone underwent preoperative biopsy revealing adenoid histology with infiltrating and nodular components. The patient underwent radical resection of the biparietal and occipital scalp, auriculectomy and craniectomy with dural resection. Immediate reconstruction of the intracranial and bony defect was performed with dural substitute and a titanium cranioplasty. The soft tissue defect was reconstructed with a latissimus dorsi free flap and split thickness skin graft using the right superficial temporal artery and vein as recipient vessels. Adjuvant external beam radiation was initiated postoperatively. Nearly 2 years postoperatively, she presented mesh exposure necessitating secondary reconstruction with debridement, hardware removal, and an anterolateral thigh (ALT) free flap, followed by flap debulking. Four years following initial presentation, she remains disease-free. To our knowledge, this is the only reported case of a giant, locally invasive scalp BCC with the adenoid subtype treated with composite resection and single stage reconstruction. Using an aggressive multimodal management paradigm, treatment and surveillance of the rarely reported, giant, locally invasive scalp BCC with adenoid subtype can result in a durable disease-free response and a functional, esthetic reconstruction. Evidence-based medicine level.

Level of Evidence: Level V, therapeutic study.


Basal cell carcinoma Adenoid basal cell carcinoma Giant basal cell carcinoma Scalp reconstruction Single stage reconstruction Free flap reconstruction 


Compliance with ethical standards

Conflict of interest

Mona Ascha, Amy Hiuser, Melissa Piliang, and Graham S. Schwarz declare that they have no conflict of interest.

Patient consent

Patient provided written consent before her inclusion in this study. Additional consent was obtained for the use of her images.

Ethical approval

For this kind of article formal consent from a local ethics committee is not required.




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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Mona Ascha
    • 1
  • Amy Hiuser
    • 1
  • Melissa Piliang
    • 2
  • Graham S. Schwarz
    • 1
    Email author
  1. 1.Department of Plastic SurgeryCleveland ClinicClevelandUSA
  2. 2.Department of DermatologyCleveland ClinicClevelandUSA

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