ORLANDO Bone or perineural involvement portends a poorer prognosis when it comes to aggressive and extensive tumors of the scalp, according to a study presented at the annual meeting of the Florida Society of Dermatologic Surgeons.
In the study, 6 of 11 patients with aggressive squamous cell carcinoma of the scalp had bone involvement, said Pearon G. Lang Jr., M.D.
"We don't think of thistumors in bony areas such as the scalp."
The nine men and two women who were diagnosed with aggressive squamous cell carcinoma over a 9-year period all had alopecia or thinning hair. "Their scalps were exposed to chronic actinic damage," explained Dr. Lang, professor of dermatology, pathology, otolaryngology, and communicative sciences at the Medical University of South Carolina, Charleston.
"You have to strip off the periosteum when these tumors go down to the bone. This may be the source of recurrence, and tumors may progress rapidly," Dr. Lang said.
Consider a CT scan but be aware, however, that pitting of the bone is helpful as a sign but not always reliable. "To cure, you must resect the bone. Decortication is not recommendedI've seen cases over the years where the tumor goes deeper," he said.
All tumors were moderately or well differentiated. A total of 4 of the 11 patients had satellite lesions, including 1 patient with a satellite lesion at time of initial treatment. Six patients developed regional or systemic metastases; five of them died.
The study also included four patients with aggressive basal cell carcinoma of the scalp.
"These aggressive basal cell carcinomas all occurred in women with full hair," Dr. Lang said.
Tumors were 3 cm or bigger in size, up to the entire vertex of the scalp. One case of basal cell carcinoma mimicked recalcitrant seborrheic dermatitis. All of the patients had Mohs surgery along with extensive reconstruction. There were no recurrences or metastases among the patients.
"Remember that a recurrent tumor can look like granulation tissue," Dr. Lang said at the meeting.
Most squamous cell and basal cell tumors recur within 26 years (average, 3 years). "You can get near a 100% cure rate if there is only skin involvement," Dr. Lang said, but there is less than a 30% cure rate if there is perineural involvement.
Perineural tumors can be asymptomatic for years. Lesions are often small and benign in appearance.
MRI imaging is preferable to CT scans, Dr. Lang said, although only 50% of patients with such tumors will have positive findings.