Locally advanced tumors of the scalp: the Egyptian National Cancer Institute experience.

Background: It is well recognized that recurrent disease can occur following malignancy in the head and neck region. This is particularly true for basal cell & squamous cell carcinoma, whereby recurrence may occur many years following initial surgery or other modalities. We report here on skin malignancy occurring in the scalp with skull invasion down to the dura mater. Composite resection of scalp, craniectomy, dural resection and reconstruction including a free tissue transfer was analyzed.

Purpose: To evaluate our experience in full thickness scalp resection and reconstruction.

Patients And Methods: At the National Cancer Institute, Cairo University, twelve patients with locally advanced tumors of the scalp invading the calvarium were treated with wide local excision of the scalp combined with underlying craniectomy and dural resection if needed. Reconstruction was completed using fascial graft for the dura, methyl methacrylate for the skull, and either giant rotational flap or free tissue transfer.

Results: Between 1998 and 2002, twelve patients with locally advanced tumors of the scalp were subjected to this surgery. All patients successfully tolerated the procedure and completely recovered with minimal morbidity with acceptable cosmetic results.

Conclusion: With the advent of free tissue transfer to cover large defects in the skull and the availability of polymethyl methacrylate (bone cement) for cranioplasty, large defects in the calvarium can be successfully resected and grafted with satisfactory outcome, improved salvage rate, and prolonged survival.