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Custom surgical management of invasive malignant tumors of the scalp

  • Original Article - Tumor - Other
  • Published:
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Abstract

Background

There is no universal management protocol concerning invasive malignant tumors of the scalp with bone and dura mater invasion. The aims of this study were to report and discuss our experience in the management of these forms of tumors.

Methods

We retrospectively reviewed all consecutive patients of microsurgical scalp reconstruction performed after resection of invasive cutaneous malignancies of the scalp, calvarium, and dura mater from 2017 to 2019, at Pitié-Salpêtrière University Hospital (Paris, France).

Results

Five patients met inclusion criteria. There were three squamous cell carcinomas and two sarcomas. Mean age at surgery was 63.6 years. The sex ratio male/female was 4. Two received radiation prior to resection and two patients had a history of prior scalp tumor surgery. All the patients underwent craniectomy and the mean cranial defect size was 41 cm2. Cranioplasty was performed in one patient. Soft tissue coverage was provided by free tissue transfer of latissimus dorsi muscle in all patients. In four patients, split thickness skin graft was performed in a second surgical stage few weeks later. There were no intraoperative complications and no complications into the donor site for the tissue transfer or the skin graft. Two patients had flap necrosis that healed after a new free flap of latissimus dorsi.

Conclusions

Wide resection with craniectomy and reconstruction with microvascular free tissue transfer provides safe and reliable treatment of recalcitrant invasive scalp skin cancers. The surgical management of these complex patients is a challenge that must be conducted by trained, experienced, and multidisciplinary teams.

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Funding

No funding was received for this research.

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Authors and Affiliations

  1. Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière-Charles Foix University Hospital, F-75013, Paris, France

    Pauline Marijon, Alexandre Carpentier, Aymeric Amelot & Bertrand Mathon

  2. Department of Maxillo-Facial Surgery and Stomatology, AP-HP, La Pitié-Salpêtrière-Charles Foix University Hospital, F-75013, Paris, France

    Chloé Bertolus, Jean-Philippe Foy, Guillaume Marechal, Jean-Baptiste Caruhel & Mourad Benassarou

  3. Sorbonne University, UPMC Univ. Paris 06, F-75005, Paris, France

    Chloé Bertolus, Jean-Philippe Foy, Alexandre Carpentier, Vincent Degos, Aymeric Amelot & Bertrand Mathon

  4. Paris Brain Institute (ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France

    Alexandre Carpentier & Bertrand Mathon

  5. Department of Anesthesia and Critical Care, AP-HP, La Pitié-Salpêtrière-Charles Foix University Hospital, F-75013, Paris, France

    Vincent Degos

Authors
  1. Pauline Marijon
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  2. Chloé Bertolus
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  3. Jean-Philippe Foy
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  4. Guillaume Marechal
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  5. Jean-Baptiste Caruhel
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  6. Mourad Benassarou
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  7. Alexandre Carpentier
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  8. Vincent Degos
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  9. Aymeric Amelot
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  10. Bertrand Mathon
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Corresponding author

Correspondence to Bertrand Mathon.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required. Informed consent was obtained from all individual participants included in the study.

Patient photographic authorization

All patients included in this study had given photographic authorization.

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Comments

Marijon and colleagues present a description of five cases of invasive malignant tumors of the scalp with bone and dura mater invasion. The paper is concisely written and the figures are informative. Further, the existing literature about this topic is quite limited.

As the authors point out, this is a rare and challenging entity. In my opinion, in line with the authors, the key point in the therapy of these tumors is a meticulous and interdisciplinary planning of the regimen and in most cases also an interdisciplinary surgical approach.

Marcus Reinges

Bremen, Germany

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Marijon, P., Bertolus, C., Foy, JP. et al. Custom surgical management of invasive malignant tumors of the scalp. Acta Neurochir 162, 2991–2999 (2020). https://doi.org/10.1007/s00701-020-04525-0

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  • DOI: https://doi.org/10.1007/s00701-020-04525-0

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