Outcomes of Cutaneous Squamous Cell Carcinomas Involving Scalp Periosteum: A Retrospective Review.

Rames, Melissa M; Demer, Addison; Baum, Christian · Mayo Clin Proc · 2026

retrospective_cohort · Level III

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Abstract

To characterize patient demographics, tumor characteristics, treatment, and outcomes for a cohort of patients with cutaneous squamous cell carcinomas invading scalp periosteum. Electronic health records from our institution were queried to identify 27 patients and 28 tumors from 2011 to 2023. Most tumors were poorly differentiated or spindled/sarcomatoid (60.8%, n=17) and Brigham and Women's Hospital/American Joint Committee on Cancer stage T2b/T3 (60.8%, n=17). All patients were treated with Mohs micrographic surgery (MMS). Seventeen patients (60.7%) received additional resection or procedures from other surgical services immediately following MMS; nine patients (32%) received adjuvant radiation, and five (18%) received adjuvant systemic therapy. The local recurrence rate was 3.6% (n=1). Five (17.9%) tumors progressed to metastatic disease (n=4 regional, n=1 distant) after an average follow up of 21.5 months. Patients with cutaneous squamous cell carcinoma involving scalp periosteum are at high risk for metastatic disease, but local control can be achieved with a multidisciplinary approach that includes MMS.