Surgical Management of Cutaneous Carcinomas Invading the Scalp: A Case Series and Proposal of a Therapeutical Algorithm.

Abstract

Invasion of deep structures of the skull by scalp lesions is a rare complication associated with these pathological entities. The management of tissue invasion is not well-defined. Reconstruction of the skin and skull defects is often challenging, and a multidisciplinary approach is essential. The aim of this study is to analyze the surgical options for managing bone and meningeal infiltration by scalp tumors and to propose a therapeutic algorithm. This single-center retrospective study included 10 patients with recalcitrant scalp tumors who underwent surgical treatment between 2019 and 2023. Clinical data were recorded, and outcome measures included duration of hospitalization, extent of tumor invasion into underlying tissues, lesion localization, surgical complications, potential adjuvant therapies, recurrence, and postoperative follow-up. A wide scalp incision around the lesion was performed in all cases. Skull infiltration was confirmed in all patients, necessitating resection of the infiltrated cranial bone with a 0.5-cm margin of healthy tissue. Meningeal infiltration was observed in 3 patients, requiring resection and subsequent duroplasty. In these cases, the resulting defect was reconstructed using polymethylmethacrylate cranioplasty and a fasciocutaneous flap. In 7 patients, a dermal substitute (Integra) was temporarily placed and later replaced with an autologous skin graft. Dura mater involvement is a critical factor to consider during surgical planning. Given the advanced age of patients affected by this condition, a less invasive approach using dermal substitutes for defect coverage is recommended whenever feasible.