Scalp cancer
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Scalp Cancer: An Overview
Introduction to Scalp Cancer
Scalp cancer, though relatively rare, presents unique challenges due to the anatomical and physiological characteristics of the scalp. The scalp's dense concentration of pilosebaceous follicles and its complex structure, including multiple layers and rich vascular supply, influence the behavior and treatment of malignant tumors in this region .
Common Types of Scalp Cancer
Basal Cell Carcinoma (BCC)
Basal cell carcinoma is the most common type of scalp cancer, particularly prevalent in individuals over 50 years old. It accounts for a significant proportion of scalp malignancies, with studies showing it comprises 41.2% of cases in Taiwanese patients and 77% of cases in women . BCCs are generally less aggressive but can cause significant local damage if not treated promptly.
Squamous Cell Carcinoma (SCC)
Squamous cell carcinoma is another frequent type of scalp cancer, making up 16.6% of cases in Taiwanese patients and being the most common type in Singapore . SCCs on the scalp can be more aggressive and have a higher tendency to recur and metastasize, especially when they invade deeper structures like the calvarium or dura .
Melanoma
Melanoma, although less common, is particularly concerning due to its aggressive nature and poor prognosis when diagnosed at an advanced stage. Scalp melanomas often exhibit more aggressive behavior compared to melanomas on other parts of the body and are frequently diagnosed late, complicating treatment and reducing survival rates .
Metastatic Tumors
Metastatic tumors to the scalp are not uncommon, with lung cancer being the most frequent primary source. These tumors account for about 12.8% of scalp malignancies in some populations, highlighting the need for thorough scalp examinations during cancer screenings .
Treatment Approaches
Surgical Resection
Surgical resection remains the cornerstone of treatment for scalp cancers. The complexity of the scalp's anatomy often necessitates a multidisciplinary approach involving neurosurgeons and plastic surgeons, especially for tumors with cranial or dural involvement . Techniques such as Mohs micrographic surgery are employed to ensure complete tumor removal while preserving as much healthy tissue as possible.
Reconstruction
Post-resection reconstruction is crucial due to the significant defects that can result from aggressive surgical interventions. The use of vascularized free tissue transfer, such as latissimus dorsi muscle flaps, is common to achieve optimal functional and aesthetic outcomes.
Multidisciplinary Management
The management of scalp cancer often requires an interdisciplinary team to address the various challenges posed by these tumors. This approach maximizes the expertise of different specialists, leading to better outcomes and reduced recurrence rates .
Prognosis and Survival
The prognosis for scalp cancer varies depending on the type and stage at diagnosis. Early detection and aggressive treatment are key to improving survival rates. For instance, the five-year survival rate for SCC of the scalp can be as high as 75% with appropriate surgical intervention. However, the overall survival and recurrence-free survival rates can be lower for more invasive tumors requiring extensive resection.
Conclusion
Scalp cancer, while uncommon, requires specialized and often aggressive treatment strategies due to the unique characteristics of the scalp. Early detection, multidisciplinary management, and advanced surgical techniques are essential to improving outcomes for patients with this challenging condition. Regular scalp examinations should be part of routine cancer screenings to facilitate early diagnosis and treatment.
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