Scalp and Forehead Cancer

Abstract

The scalp covering the cranium and especially the balding scalp is subject to the damaging effects of ultraviolet light and therefore a frequent site for all the common skin cancers. These arise in the epidermis and include basal cell carcinoma, squamous cell carcinoma and malignant melanoma. Less common tumours of the dermis and adnexal structures may occur. The presence of a good head of hair may paradoxically disguise and delay the diagnosis of scalp cancers. The excellent blood supply to the scalp may enhance tumour growth and the reliability of skin graft and flap healing after tumour excision. Moderate or large sized tumours (T2–T4) can present a reconstructive challenge, particularly if deeper structures, such as the underlying calvarial bone, have been infiltrated. If the meninges are involved, then serious intracranial extension and sepsis become a specific risk factor, with life-threatening consequences. A wide range of reconstructive techniques are available to the surgeon based on the standard plastic surgeon’s repertoire of methods. Collaboration with neurosurgeons and craniofacial surgeons is recommended in the extreme cases. Radiotherapy is part of the adjunctive treatment particularly for the high-grade tumours or where perineural and/or lymphovascular invasion is detected histologically. Recurrence of scalp cancer following previous radiotherapy, where osteo-radionecrosis is complicating the clinical presentation, is a particular scenario where the plastic surgical/neurosurgical/anaesthetic/peri-operative and the nursing care need careful planning and safe protocols.