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Leal Z, Hobbs M, Gill R, Banfield M, Akhdar M, Casadesus D. Rapidly Growing Giant Squamous Cell Carcinoma of the Head: A Case Report. Cureus 2024; 16:e59630. [PMID: 38832174 PMCID: PMC11146447 DOI: 10.7759/cureus.59630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/05/2024] Open
Abstract
Giant squamous cell carcinoma (GSCC) of the skin arising on the head presents a distinctive clinical challenge due to its rarity, aggressive behavior, and potential for disfigurement. A male in his 70s with a history of tobacco cigarette use presented to the emergency department with a painful, bleeding mass on the right parietal scalp. On admission, a brain CT revealed a fungating mass with no cortical breakthrough or osseous erosion, measuring 7.9 x 5.7 x 2.5 cm. An ultrasound-guided tissue biopsy was performed and revealed poorly differentiated squamous cell carcinoma. The patient was discharged home with instructions from oncology to continue with outpatient treatment. At this time, the prognosis is good if treatment is received.
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Affiliation(s)
- Zachary Leal
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
| | - Mikayla Hobbs
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
| | - Razia Gill
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
| | - Megan Banfield
- Medicine and Surgery, Jackson Memorial Hospital, Miami, USA
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Otieno DO, Ouma NO, Malik JH, Nang'ole F. A staged approach for complex scalp defects using titanium mesh and anterolateral thigh flaps: Two case reports. Int J Surg Case Rep 2023; 110:108766. [PMID: 37657388 PMCID: PMC10510075 DOI: 10.1016/j.ijscr.2023.108766] [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: 08/05/2023] [Revised: 08/26/2023] [Accepted: 08/27/2023] [Indexed: 09/03/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Scalp tumors are diverse, with the characteristics of individual tumors depending on the cell lineage. Invasive squamous cell carcinoma and sarcomas of the scalp are a variety of uncommon, aggressive neoplasms of the head and neck. Resecting large invasive tumors causes extensive full-thickness scalp defects, and repairing these defects remains challenging. CASE PRESENTATION The authors present two successful cases using a staged approach with titanium mesh and free tissue transfer (anterolateral thigh flap) technique. CLINICAL DISCUSSION Complex scalp defects are challenging to manage when insufficient local tissue is available. This frequently necessitates the use of microvascular free tissue transfer for reconstruction. The availability of microsurgery in developing countries such as ours has enabled functional and aesthetic reconstruction for patients presenting with such complex defects. CONCLUSION Free flaps are safe and reliable when scalp defects are significant and require both scalp and calvarial reconstructions. The ALT-free tissue transfer shows predictable results in both clinical cases.
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Affiliation(s)
- Daniel O Otieno
- Department of Plastic, Reconstructive and Aesthetic Surgery University of Nairobi School of Medicine, Nairobi, Kenya.
| | - Nelson Oduor Ouma
- Department of Plastic, Reconstructive and Aesthetic Surgery University of Nairobi School of Medicine, Nairobi, Kenya
| | - Janan Hania Malik
- Department of Plastic, Reconstructive and Aesthetic Surgery University of Nairobi School of Medicine, Nairobi, Kenya
| | - Ferdinand Nang'ole
- Department of Plastic, Reconstructive and Aesthetic Surgery University of Nairobi School of Medicine, Nairobi, Kenya
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Rauchenwald T, Augustin A, Steinbichler TB, Zelger BW, Pierer G, Schmuth M, Wolfram D, Morandi EM. Resection of Skin Cancer Resulting in Free Vascularized Tissue Reconstruction: Always a Therapeutic Failure? Cancers (Basel) 2023; 15:cancers15092464. [PMID: 37173928 PMCID: PMC10177333 DOI: 10.3390/cancers15092464] [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: 03/09/2023] [Revised: 04/14/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
The globally increasing incidence of cutaneous malignancies leads, in parallel, to increasing numbers of locally advanced skin cancer resulting in reconstructive surgery. Reasons for locally advanced skin cancer may be a patient's neglect or aggressive tumor growth, such as desmoplastic growth or perineural invasion. This study investigates characteristics of cutaneous malignancies requiring microsurgical reconstruction with the aim of identifying possible pitfalls and improving diagnostic and therapeutic processes. A retrospective data analysis from 2015 to 2020 was conducted. Seventeen patients (n = 17) were included. The mean age at reconstructive surgery was 68.5 (±13) years. The majority of patients (14/17, 82%) presented with recurrent skin cancer. The most common histological entity was squamous cell carcinoma (10/17, 59%). All neoplasms showed at least one of the following histopathological characteristics: desmoplastic growth (12/17, 71%), perineural invasion (6/17, 35%), or tumor thickness of at least 6 mm (9/17, 53%). The mean number of surgical resections until cancer-free resection margins (R0) were achieved was 2.4 (±0.7). The local recurrence rate and the rate of distant metastases were 36%. Identified high-risk neoplastic characteristics, such as desmoplastic growth, perineural invasion, and a tumor depth of at least 6 mm, require a more extensive surgical treatment without concerns about defect size.
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Affiliation(s)
- Tina Rauchenwald
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Tyrol, Austria
| | - Angela Augustin
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Tyrol, Austria
| | - Theresa B Steinbichler
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Tyrol, Austria
| | - Bernhard W Zelger
- Private Praxis for Dermatopathology Innsbruck & Zams, 6020 Innsbruck, Tyrol, Austria
| | - Gerhard Pierer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Tyrol, Austria
| | - Matthias Schmuth
- Department of Dermatology, Venerology and Allergology, Medical University of Innsbruck, 6020 Innsbruck, Tyrol, Austria
| | - Dolores Wolfram
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Tyrol, Austria
| | - Evi M Morandi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Tyrol, Austria
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Advanced or Metastatic Cutaneous Squamous Cell Carcinoma: The Current and Future Role of Radiation Therapy in the Era of Immunotherapy. Cancers (Basel) 2022; 14:cancers14081871. [PMID: 35454779 PMCID: PMC9032290 DOI: 10.3390/cancers14081871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary Nodal and distant metastases of cutaneous squamous cell carcinomas are very rare and lead to dismal prognoses. Immunotherapy is approved only for cutaneous squamous cell carcinoma patients not amenable to surgery or curative radiation therapy. Radiation therapy has a clear role as an adjuvant treatment for locally advanced disease. Radiation therapy may also have an important role in inoperable and metastatic disease. Oligometastatic disease is a condition that needs to be defined for this carcinoma. This review aims to offer to the readers a comprehensive overview of studies about the role of radiotherapy in the management of advanced or metastatic cutaneous squamous cell carcinomas, also assuming possible further developments in the light of the recent discoveries about tumor biology. The present paper has the merit of re-focusing great attention on the efficacy and cost-effectiveness of radiotherapy in these not yet properly explored scenarios. Abstract Radiation therapy (RT) is an effective therapeutic option for small localized cutaneous squamous cell carcinoma (cSCC) among patients who are not eligible for or refuse surgery. RT also has a defined role as an adjuvant treatment in cases of adverse features that predispose to tumor recurrence after local excision. Since the development of cSCC is often a late consequence of chronic sun exposure, its occurrence is more common among elderly patients whose comorbidities may contraindicate surgical procedures. These could be impeded not only by frail medical conditions but also by technical issues. Indeed, an aggressive locoregional behavior of cSCC may culminate in unresectability due to widespread invasion of neighboring tissues. Moreover, cSCC could develop distant metastases. Both locally advanced and metastatic cSCCs carry a poor prognosis. In these scenarios, recent discoveries of tumor molecular targets are promoting the use of promising systemic therapies, especially immunotherapy, over RT. However, the results from using immunotherapy and, even more so, of chemotherapy are still not optimal. By contrast, advances in radiation delivery equipment can safely treat even large and complex-shaped cSCC targets in challenging body sites. In addition, RT could also have a role in metastatic cSCC settings by enhancing the effectiveness of concomitant immunotherapy. The aim of this review is to summarize and comment on the body of literature about the use of radiotherapy for operable and inoperable locally advanced cSCCs and for metastatic ones in an attempt to define its current and future role.
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Choi JH, Oh HM, Kim KS, Choi YD, Joo SP, Hwang WJ, Hwang JH, Lee SY. Primary cutaneous apocrine carcinoma of the scalp: Two case reports and literature review. Medicine (Baltimore) 2022; 101:e28808. [PMID: 35147116 PMCID: PMC8830877 DOI: 10.1097/md.0000000000028808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/25/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Apocrine carcinoma is a rare malignant sweat gland tumor that has been reported in approximately 200 cases. This tumor usually occurs in the axilla, but in rare cases, it can also develop in the scalp. In the present work, we report 2 cases of cutaneous apocrine carcinoma of the scalp. PATIENT CONCERNS Two men visited our outpatient clinic with recurrence of tumor after undergoing surgery for scalp tumor at another hospital. DIAGNOSES Brain magnetic resonance imaging of a 56-year old man showed the presence of a 5.0 × 4.5 × 4.4 cm scalp mass in the right parietal region, invading the skull and dura mater and a 2.2 × 2.0 × 0.7 cm bony mass without any skin lesions right next to the scalp mass. Neck magnetic resonance imaging of a 76-year-old man revealed the presence of a well-defined oval mass in the subcutaneous layer of the left occipital scalp and 2 enlarged lymph nodes in the left neck. Definite diagnoses were made postoperatively. The patients were diagnosed with cutaneous apocrine carcinoma. The diagnosis was confirmed through histopathological and immunohistochemical staining tests. INTERVENTIONS The tumors were removed with a wide safety margin and reconstructive surgery was performed. OUTCOMES Additional radiotherapy or chemotherapy was performed. Follow-up more than 6 months revealed no recurrence or metastasis. LESSONS If accurate diagnosis and treatment had taken place at the initial stages of the primary cutaneous apocrine carcinoma, it would have been possible to prevent recurrence and intracranial invasion. As recurrent primary cutaneous apocrine carcinoma can become aggressive and difficult to treat, even a small mass on the scalp must be evaluated carefully and treated properly.
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Affiliation(s)
- Jun Ho Choi
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hyun Myung Oh
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kwang Seog Kim
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Yoo Duk Choi
- Department of Pathology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Sung Pil Joo
- Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Won Joo Hwang
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jae Ha Hwang
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Sam Yong Lee
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
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Brambullo T, Azzena GP, Toninello P, Masciopinto G, De Lazzari A, Biffoli B, Vindigni V, Bassetto F. Current Surgical Therapy of Locally Advanced cSCC: From Patient Selection to Microsurgical Tissue Transplant. Review. Front Oncol 2021; 11:783257. [PMID: 34950589 PMCID: PMC8690035 DOI: 10.3389/fonc.2021.783257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022] Open
Abstract
Among the non-melanoma skin cancers (NMSC) the squamous cell carcinoma (SCC) is one of the most challenging for the surgeon. Local aggressiveness and a tendency to metastasize to regional lymph nodes characterize the biologic behavior. The variants locally advanced and metastatic require wide excision and node dissection. Such procedures can be extremely detrimental for patients. The limit of the surgery can be safely pushed forward with a multidisciplinary approach. The concept of skin oncoplastic surgery, the ablative procedures and the reconstructive options (skin graft, pedicled flap, microsurgical free flap) are discussed together with a literature review.
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Affiliation(s)
- Tito Brambullo
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Gian Paolo Azzena
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Paolo Toninello
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Giuseppe Masciopinto
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Alberto De Lazzari
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Bernardo Biffoli
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Vincenzo Vindigni
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Franco Bassetto
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
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Ryu HR, Lee DW, Choi HJ, Kim JH, Ahn H. Scalp metastasis of advanced gastric cancer. Arch Craniofac Surg 2021; 22:157-160. [PMID: 34225408 PMCID: PMC8257450 DOI: 10.7181/acfs.2021.00129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/20/2021] [Indexed: 12/22/2022] Open
Abstract
Head and neck cutaneous metastasis of advanced gastric cancer is uncommon, and scalp metastasis is particularly rare. We present the case of a 60-year-old man who was diagnosed with cutaneous metastasis on the scalp originating from advanced gastric cancer. The patient was referred to the plastic surgery department for a scalp mass near the hairline. He had been diagnosed with advanced gastric cancer and undergone total gastrectomy and Roux esophagojejunostomy 3 years previously. The differential diagnosis for a single flesh-colored nodule on the scalp included benign tumors such as epidermal cyst or lipoma; therefore, the patient underwent excision and biopsy. In the operative field, the mass was found to be located in the frontalis muscle. The biopsy result showed that the mass was a metastatic lesion of advanced gastric cancer. Whole-body computed tomography revealed a gastric tumor with blood vessel infiltration, peritoneal carcinomatosis, liver metastasis, and multiple disseminated subcutaneous metastases. Although scalp metastasis originating from an internal organ is extremely rare, plastic surgeons should always consider a metastatic lesion in the differential diagnosis if a patient with a scalp lesion has a history of malignant cancer.
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Affiliation(s)
- Hyeong Rae Ryu
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Da Woon Lee
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hwan Jun Choi
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jun Hyuk Kim
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hyein Ahn
- Department of Pathology, Soonchunhyang University College of Medicine, Cheonan, Korea
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