Basal cell carcinoma of the scalp with destruction and invasion into the calvarium and dura mater: Report of 7 cases and review of literature. (January 2018)

• Record Type: Journal Article
• Authors: Kwon, Churl-Su; Awar, Omar Al; Ripa, Valeria; Said, Ghassan; Rocka, Saulius
• Is Part Of: Journal of clinical neuroscience. Volume 47(2018)
• Page Start: 190
• Page End: 197
• Publication Date: 2018-01
• Subjects: Basal cell carcinoma -- Intracranial extension -- Dural invasion -- Reconstruction; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2017.09.028
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Basal cell carcinoma (BCC) is the most common skin malignancy in humans. Giant BCC - a rarer entity that is characterised by aggressive biological behaviour. Largest series of recurrent BCCs with intracranial extension involving the dura. Longest mean follow-up of 5.3 years in these patients with good survival rates. MDT, aggressive resection/reconstruction are reliable treatment modalities. Abstract: Basal cell carcinoma (BCC) is the most common skin malignancy in humans. Giant BCC is a rarer entity that is characterised by aggressive biological behaviour. Intracranial invasion by a BCC on the scalp is extremely rare. The gold standard treatment of BCCs is represented by surgical excision with a wide variety of reconstructive techniques. In this paper, we describe the largest series to date of recurrent BCCs with intracranial extension involving the dura mater. We report recurrent giant BCC of the scalp with dura mater invasion in 7 patients. All patients in this series previously had more than 2 operations. Gadolinium-enhanced MRI revealed neoplastic invasion of the meninges and brain tissues. All patients had a multi-disciplinary team approach with the surgical margins ranging between 1 and 2 cm depending on the location and the size of the tumour. 5 of the patients underwent reconstruction of the skin defect by antero-lateral thigh flap, 1 patient underwent reconstruction with pedicled myocutaneous (trapezius) flap, and 1 with a pedicled myocutaneous latissimus dorsi flap. There was a mean follow-up of 5.3 years. 2 patients died due to cardio-pulmonary complications in the neuro-intensive care unit. A multi-disciplinary team approach and early aggressive tumour resection followed by sophisticated reconstructive and aesthetic procedures appears to be a reliable and realistic treatment modality for invasive BCC.