Squamous cell carcinoma scalp
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Squamous Cell Carcinoma of the Scalp: An Overview
Introduction to Squamous Cell Carcinoma of the Scalp
Squamous cell carcinoma (SCC) is a common type of skin cancer that arises from the malignant proliferation of keratinocytes. It is the second most prevalent skin cancer after basal cell carcinoma (BCC) and can present in various forms, including erythematous patches, nodules, and ulcerative lesions. When SCC occurs on the scalp, it can exhibit particularly aggressive behavior, often leading to severe complications and challenging treatment scenarios .
Aggressiveness and Complications
High Metastasis and Recurrence Rates
SCC of the scalp is known for its aggressive nature, with a high tendency to metastasize and recur. Studies have shown that SCCs arising in chronic inflammatory lesions or scars, such as those seen in dissecting perifolliculitis of the scalp, have a significantly higher metastasis rate compared to those arising from actinic keratoses. This necessitates early and aggressive treatment to improve patient outcomes .
Invasion and Metastasis
SCC of the scalp can invade local structures, including bone and even the brain. Cases have been reported where SCC extended into the skull and dura mater, highlighting the potential for severe local invasion . Additionally, the development of satellite lesions and recurrence despite clear surgical margins further complicates treatment.
Treatment Approaches
Surgical Interventions
Surgery remains the primary treatment modality for SCC of the scalp. Mohs micrographic surgery is often employed due to its precision in removing cancerous tissue while sparing healthy tissue. However, even with this technique, recurrence can occur, necessitating additional interventions . Wide excision with margin control followed by split-thickness grafting and postoperative irradiation is recommended in cases with satellitosis.
Palliative Care
In advanced cases where surgery and other aggressive treatments are not viable, palliative care becomes essential. This involves managing symptoms such as pain, exudate, bleeding, and odor to improve the patient's quality of life. Advanced SCC with brain exposure, for instance, requires meticulous wound care and infection control.
Prognosis and Survival Rates
The prognosis for SCC of the scalp varies depending on the stage at diagnosis and the extent of invasion. Historical data indicate a five-year survival rate of 75% for patients treated primarily with surgery. However, the presence of complications such as cervical metastases significantly impacts survival outcomes .
Conclusion
Squamous cell carcinoma of the scalp is a particularly aggressive form of skin cancer with a high propensity for local invasion and metastasis. Early diagnosis and aggressive treatment are crucial to improving patient outcomes. Surgical intervention remains the cornerstone of treatment, but advanced cases may require a multidisciplinary approach, including palliative care. Understanding the aggressive nature of SCC of the scalp underscores the importance of early detection and comprehensive management strategies.
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