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Verdaguer-Faja J, Guerra-Amor Á, Ferrándiz-Pulido C, Abril-Pérez C, Botella Estrada R, Masferrer E, Lopez-Castillo D, Deza G, Leal L, Marti-Marti I, Ruiz-Salas V, Yébenes M, Marqués Martin L, Baliu C, Castany A, Boada A, Toll A, Jaka A. Histological deep margins in cutaneous squamous cell carcinoma of the scalp and risk of recurrence. J Eur Acad Dermatol Venereol 2024. [PMID: 39036869 DOI: 10.1111/jdv.20250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/26/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Consensus is lacking on adequate deep histological margins in cutaneous squamous cell carcinoma (cSCC). Deep clearance for tumours located on the scalp is limited by anatomic constraints. OBJECTIVE To determine whether clear but close deep histological margins (<1 mm) confer a higher risk of recurrence in cSCCs of the scalp treated by wide local excision, compared to deep histological margins ≥1 mm. METHODS Multicentre retrospective observational cohort study and multivariate competing risk analysis to evaluate risk factors for recurrence. RESULTS In total, 295 patients with 338 cSCCs were included. Close deep histological margins were not associated with an increased cumulative incidence of recurrence (subhazard ratio [SHR] 1.96 [95% CI 0.87-4.41]). However, an increased risk of recurrence was observed for those tumours that presented concurrent invasion of the galea aponeurotica and close deep margins, as opposed to patients without these factors (SHR 3.52 [1.24-10.01]). Tumours with clear but close peripheral margins (<1 mm) also had higher risk of recurrence (SHR 5.01 [1.68-14.97]). LIMITATIONS Retrospective observational study based on pathology reports. CONCLUSION Deep histological margins <1 mm do not confer a greater risk of recurrence as long as the tumour is completely excised and the galea aponeurotica is not involved. Surgical excision of cSCC on the scalp should include the galea to ensure proper assessment of deep margins.
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Affiliation(s)
- Júlia Verdaguer-Faja
- Departament de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Álvaro Guerra-Amor
- Department of Dermatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carla Ferrándiz-Pulido
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Department of Dermatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlos Abril-Pérez
- Department of Dermatology, Hospital Universitario La Fe, Instituto de Investigación Sanitaria La Fe (ISS La Fe), Valencia, Spain
| | - Rafael Botella Estrada
- Department of Dermatology, Hospital Universitario La Fe, Instituto de Investigación Sanitaria La Fe (ISS La Fe), Valencia, Spain
- Universidad de Valencia, Valencia, Spain
| | - Emili Masferrer
- Department of Dermatology, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | | | - Gustavo Deza
- Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Lorena Leal
- Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Ignasi Marti-Marti
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Verónica Ruiz-Salas
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Mireia Yébenes
- Department of Dermatology, Hospital Parc Taulí, Sabadell, Spain
| | | | - Carola Baliu
- Department of Dermatology, Hospital Universitari d'Igualada, Igualada, Spain
| | - Anna Castany
- Department of Dermatology, Hospital Universitari d'Igualada, Igualada, Spain
| | - Aram Boada
- Departament de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Agustí Toll
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Ane Jaka
- Departament de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Mahmood M, Eisen D. An algorithmic approach to scalp reconstructive surgery: maximization of cosmetic and functional outcomes. Arch Dermatol Res 2024; 316:137. [PMID: 38683230 PMCID: PMC11058610 DOI: 10.1007/s00403-024-02896-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 02/18/2024] [Accepted: 04/16/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Scalp reconstruction requires knowledge of scalp anatomy and reconstructive options. Advances in the field have led to numerous procedures being at the disposal of the reconstructive surgeon, expanding treatment options for patients. OBJECTIVE To provide an algorithmic approach and general guidelines to consider when deciding on which scalp surgery will optimize cosmetic and functional outcomes. METHODS & MATERIALS Previous literature was searched for the last 20 years to provide an updated guide. RESULTS Taking into consideration the location, size and local scalp anatomy of a presenting defect will lead to optimal surgical outcomes. Other confounding factors such as bone exposure and extremely large defects will affect decision making. An algorithmic approach has been provided in this review. CONCLUSION While many reconstructive surgical options are available, the best ones will depend on individual presentation of scalp defects. Location and size are first line considerations while local scalp anatomy will allow for tailoring of reconstructive options. This will help to maximize cosmetic and aesthetic considerations.
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Affiliation(s)
| | - Daniel Eisen
- Department of Dermatology, University of California Davis Medical Center, Sacramento, CA, USA.
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Verdaguer-Faja J, Toll A, Boada A, Guerra-Amor Á, Ferrándiz-Pulido C, Jaka A. Management of Cutaneous Squamous Cell Carcinoma of the Scalp: The Role of Imaging and Therapeutic Approaches. Cancers (Basel) 2024; 16:664. [PMID: 38339415 PMCID: PMC10854799 DOI: 10.3390/cancers16030664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common subtype of skin cancer. The scalp is one of the most frequently affected locations and is associated with a higher rate of complications, compared to other locations. In addition, it has a characteristic thickness and anatomical structure that may influence both growth pattern and treatment of primary cSCC; while clinical peripheral margins may be easily achieved during the surgery, vertical excision of the tumor is limited by the skull. Despite having a unique anatomy, current guidelines do not contemplate specific recommendations for scalp cSCC, which leads to inconsistent decision-making in multidisciplinary committees when discussing tumors with high risk factors or with close margins. This article provides specific recommendations for the management of patients with scalp cSCC, based on current evidence, as well as those aspects in which evidence is lacking, pointing out possible future lines of research. Topics addressed include epidemiology, clinical presentation and diagnosis, imaging techniques, surgical and radiation treatments, systemic therapy for advanced cases, and follow-up. The primary focus of this review is on management of primary cSCC of the scalp with localized disease, although where relevant, some points about recurrent cSCCs or advanced disease cases are also discussed.
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Affiliation(s)
- Júlia Verdaguer-Faja
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (J.V.-F.); (A.B.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Agustí Toll
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Aram Boada
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (J.V.-F.); (A.B.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Álvaro Guerra-Amor
- Department of Dermatology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
| | - Carla Ferrándiz-Pulido
- Departament de Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
- Department of Dermatology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
| | - Ane Jaka
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (J.V.-F.); (A.B.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
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Kim M, Kim JW, Shin JW, Na JI, Huh CH. Basal cell carcinoma of the scalp shows distinct features from the face in Asians. Sci Rep 2022; 12:10183. [PMID: 35715697 PMCID: PMC9205873 DOI: 10.1038/s41598-022-14533-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 06/08/2022] [Indexed: 11/27/2022] Open
Abstract
Basal cell carcinoma (BCC) affecting different sites has been reported to have different clinicopathological features. In previous studies, the scalp was commonly classified to the head and neck region. However, the scalp has distinct characteristics from those of other parts of the skin. We retrospectively reviewed the medical records of patients who underwent surgical treatment for BCC. A total of 734 lesions were examined, and 13.2% originated from the scalp. The nodular type was the most common histologic subtype; however, the proportion of the superficial type was significantly higher than that of facial BCC (p < 0.001). Compared with facial BCC, younger age (p = 0.046) and larger tumor size (p < 0.001) were observed in scalp BCC. These characteristics were similar to those of truncal BCC in that they demonstrated a higher proportion of the superficial type (p < 0.001), younger age (p = 0.001), and larger tumor diameter (p < 0.001) compared with BCC in the head and neck region. Scalp BCC and truncal BCC were not significantly different in terms of age (p = 0.052) and tumor size (p = 0.230). In conclusion, despite the anatomical proximity, features of scalp BCC were similar to those of truncal lesions compared with facial lesions. Scalp BCC might be a separate entity from facial BCC.
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Affiliation(s)
- Minsu Kim
- Department of Dermatology, Seoul National University Bundang Hospital, 82 Gumi-Ro 173 Beon-Gil, Seongnam, 13620, Gyeonggi, Korea
| | - Jee-Woo Kim
- Department of Dermatology, Seoul National University Bundang Hospital, 82 Gumi-Ro 173 Beon-Gil, Seongnam, 13620, Gyeonggi, Korea
| | - Jung-Won Shin
- Department of Dermatology, Seoul National University Bundang Hospital, 82 Gumi-Ro 173 Beon-Gil, Seongnam, 13620, Gyeonggi, Korea
| | - Jung-Im Na
- Department of Dermatology, Seoul National University Bundang Hospital, 82 Gumi-Ro 173 Beon-Gil, Seongnam, 13620, Gyeonggi, Korea
| | - Chang-Hun Huh
- Department of Dermatology, Seoul National University Bundang Hospital, 82 Gumi-Ro 173 Beon-Gil, Seongnam, 13620, Gyeonggi, Korea.
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