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The Role of Resection of the Outer Table of the Cranium in Locally Invasive Primary Squamous Cell Carcinoma of the Scalp
Garrison A Leach MD1, Lacey R Pflibsen MD2, Denzil P Mathew BS3, Ayushi D Sharma BS3, Christopher M Reid MD1, Travis C Holcombe MD2,3 1Division of Plastic Surgery, Department of Surgery, University of California, San Diego, San Diego, CA 2Division of Plastic Surgery, Mayo Clinic Arizona, Phoenix, AZ 3Creighton University, School of Medicine, Phoenix, AZ

Background: Squamous cell carcinoma is one of the most common and aggressive malignancies of the scalp. Invasive lesions involving pericranium may require extensive resection, including possible removal of cranial bone. There is limited description of the role of and utility of cranial bone resection in invasive squamous cell carcinomas of the scalp. We present a retrospective review assessing the benefit of resection of the outer table of the cranium for squamous cell carcinoma of the scalp invading the pericranium.

Methods: Twenty-two cases from 2013-2020 met study criteria and were included in this analysis. Sixteen cases of outer table resection and 6 cases of full craniectomy were analyzed. Additionally, the authors' surgical approach for resection and reconstruction is articulated.

Results: Sixteen patients underwent outer table resection at a mean age of 79.2 years. All lesions had invasion of the pericranium with a mean surface area of 42.2 cm2. Seven patients had prior radiation treatment for squamous cell carcinoma of the scalp and 11 patients had at least one prior surgery to attempt excision of their lesions. Two patients had local recurrence for a local control rate of 87.5% (14/16). One patient with metastasis prior to presentation, died 6 months after his initial surgery for a survival rate of 93.8% (15/16) at a mean of 15.6 months. Three patients (18.8%) received adjuvant radiation therapy and 1 patient (6.3%) received immunotherapy. In regards to reconstruction, 8 patients received local scalp flaps and immediate autografting to the donor site, 3 patients received local scalp flaps alone, 4 patients had dermal regeneration templates placed with delayed autografting, and 1 patient had immediate autografting.

Conclusion: The results of this study support that this method is an excellent option for patients with primary, locally invasive squamous cell carcinoma of the scalp. This approach mitigates anesthesia time and allows for immediate, reliable reconstruction as seen in the majority of our patients. Our data supports the safety of this procedure as we report no complications with outer table resection. Lastly, it is oncologically efficacious as our recurrence and survival rates were improved compared to the literature for T3 and T4 squamous cell carcinomas of the scalp.

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