Purpose
Queensland is third-most populous state in Australia and yet has the highest incidence of Non Melanoma Skin Cancer (NMSC) in Australia.1 Squamous Cell Carcinoma (SCC) is the second most common tumour of the scalp and can present with advanced disease posing unique challenges for surgical reconstruction and curative outcomes.
We present our surgical experience of scalp SCC in a tertiary plastic surgery centre evaluating prognostic factors, reconstruction options and clinical outcomes.
Methodology
Over a four year period (2014 to 2017) we retrospectively reviewed patients with cutaneous SCC of the scalp treated by surgical excision at the Royal Brisbane and Women's Hospital, Brisbane, Queensland. These data were analysed for clinical demographics, pathological features, surgical management and outcomes (recurrence or mortality).
Results
There were 239 scalp SCCs in 215 patients. The majority of patients were male (95%) with a median age of 75 years. Important risk factors at presentation were noted in the cohort; immunocompromised (4%), previous radiotherapy (14%), regional lymphadenopathy (3%) and involvement of the skull (6%). The majority of tumours were pathologically moderate (45%) or poorly (29%) differentiated, with an overall mean depth of 6mm (range 0.9 – 35 mm). Furthermore, perineural invasion was noted in 11% of tumours. Clear surgical margins were achieved in 95% of patients. Scalp defects were reconstructed utilising skin grafting (51%), local flaps (34%) and free flaps (6%). Clinical outcomes at 5 years were disease free progression (70%) and disease specific mortality (10%).
Conclusion
Our experience of scalp SCC highlights a high risk patient population presenting with pathologically advanced tumours. We advocate an aggressive surgical excision with appropriate reconstruction to achieve clearance margins and optimise overall clinical outcomes.