Skull Base Surgery for the Management of Deeply Invasive Scalp Cancer

Donald, Paul J.; Boggan, James E.; Farwell, D. Gregory; Enepekides, Danny

doi:10.1055/s-0031-1284216

Cited by 23 publications

(41 citation statements)

References 14 publications

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“…4 Treatments for skull base invasion of NMSCs usually consists of comprehensive surgical resection followed by adjuvant radiation; however, reports have been published regarding the success of definitive chemoradiotherapy. 7,10 Skull base invasion of nonmelanoma head and neck skin cancers predominantly occurs by two routes: direct invasion There is no further anatomical barrier for tumor invasion to extend intracranially once the perineurium is involved. Direct invasion is often seen with scalp head and neck NMSC.…”

Section: Discussionmentioning

confidence: 99%

Skull Base Invasion Patterns and Survival Outcomes of Nonmelanoma Skin Cancers

et al. 2016

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Report routes of skull base invasion for head and neck nonmelanoma skin cancers (NMSCs) and their survival outcomes. Retrospective. Ninety patients with NMSC with skull base invasion between 2004 and 2014. Demographic, tumor characteristics, and treatments associated with different types of skull base invasion and disease-specific survival (DSS) and overall survival (OS). Perineural invasion (PNI) to the skull base occurred in 69% of patients, whereas 38% had direct skull base invasion. Age, histology, orbital invasion, active immunosuppression, cranial nerve (CN) involved, and type of skull base invasion were significantly associated with DSS and OS ( < 0.05). Patients with basal cell carcinoma (BCC) had significantly improved DSS and OS compared with other histologies ( < 0.05). Patients with CN V PNI had significantly improved DSS and OS compared with CN VII PNI ( < 0.05). Patients with zone II PNI had significantly improved DSS and OS compared with those with direct invasion or zone III PNI ( < 0.05). Nonsurgical therapy was rarely used and is associated with a reduction in DSS and OS ( < 0.05). Patterns and survival outcomes for NMSC skull base invasion are reported. Zone II PNI, BCC, and CN V PNI are associated with improved survival outcomes.

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Section: Discussionmentioning

confidence: 99%

Skull Base Invasion Patterns and Survival Outcomes of Nonmelanoma Skin Cancers

et al. 2016

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“…However, the local control rate was not stratified based on depth of invasion and included patients with superficial, intermediate, and deep invasion. 3 A study by Panizza et al of 21 patients with large nerve perineural invasion of head and neck squamous cell carcinoma reported a local recurrence rate of 23.8%. This was not specific to the scalp and only included the subset of cases with perineural invasion.…”

Section: Discussionmentioning

confidence: 98%

“…When neglected or when patients fail prior attempts of treatment, these skin cancers can grow to involve a significant area of the scalp and potentially invade into underlying periosteum, calvarium, dura, and even cerebrum. 3 Unfortunately, skin cancers that invade underlying tissue are often not amenable to cure with MMS.…”

Section: Introductionmentioning

confidence: 99%

Oncologic Outcomes of Invasive Squamous Cell Carcinoma of the Scalp Requiring Resection of Cranial Bone

Ziegler

Walker

Varvares

2016

J Neurol Surg A Cent Eur Neurosurg

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Objectives To identify the recurrence rates and survival outcomes of patients with invasive squamous cell carcinoma of the scalp. Methods This study was a retrospective chart review of eight patients that had squamous cell carcinoma of the scalp with either periosteal or skull invasion on clinical and/or radiographic evaluation. Results The disease-free survival was 62.5% (5/8 patients) with a local control rate of 75% (6/8 patients) for the entire group. The two patients with full-thickness craniectomy had a local control rate of 100% (2/2 patients); the patients with outer cortex removal had a local control rate of 66.7% (4/6 patients). The disease-free survival of the full-thickness group was 50% (1/2 patients ), and the disease-free survival of the outer cortex removal patients was 66.7% (4/6 patients). Conclusion Despite the invasive nature of this disease, a high degree of local control can be achieved in this high-risk group with multiple comorbidities using outer cortex drilldown, and, in properly selected patients, full-thickness calvarial resection. We conclude that for patients without evidence of medullary involvement that outer table drilldown offers a well-tolerated approach with reasonable oncologic control.

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“…The periosteum and the underlying skull should be examined clinically for signs of invasion. Early signs of outer cortex invasion are bone stippling and difficulty in peeling off the periosteum [ 4 ]. If no signs of clinical invasion are present in the periosteum and the skull, then only the outer table of the calvaria should be removed.…”

Section: Discussionmentioning

confidence: 99%

A case series on the conservative management of the bony skull in patients with aggressive skin carcinomas of the scalp

Leow

Fleming

Oakley

2018

Journal of Surgical Case Reports

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Few studies examine techniques of surgical resection for scalp malignancies to ensure clear margins. We present a case series utilizing outer cortex removal in patients without evidence of bony or pericranial invasion. A retrospective casenote review is presented of three cases treated in a tertiary Head and Neck Cancer Centre. An outer table removal approach was utilized based on the absence of bony involvement either on pre-operative imaging or from intra-operative findings. All cases underwent an outer table drilldown procedure. Tumour histology included high grade carcinoma of unknown origin, malignant cylindroma and squamous cell carcinoma. Complete excisions with adequate deep margins were achieved in 100% cases. Overall disease-free survival was 66.6% and local control rate was 100%. This technique allows a high degree of local control, notably at the deep margin. There is little morbidity and it avoids the complications associated with full thickness calvarial resection.

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Skull Base Surgery for the Management of Deeply Invasive Scalp Cancer

Cited by 23 publications

References 14 publications

Skull Base Invasion Patterns and Survival Outcomes of Nonmelanoma Skin Cancers

Skull Base Invasion Patterns and Survival Outcomes of Nonmelanoma Skin Cancers

Oncologic Outcomes of Invasive Squamous Cell Carcinoma of the Scalp Requiring Resection of Cranial Bone

A case series on the conservative management of the bony skull in patients with aggressive skin carcinomas of the scalp

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