Aggressive Squamous Carcinomas of the Scalp

The document summarizes findings from a study of 11 cases of aggressive squamous cell carcinomas (SCCs) of the scalp, which were characterized by their high recurrence rate after Mohs surgery, development of satellite lesions, bone invasion, and regional and systemic metastasis. Five of the 11 patients died from the disease. All patients had long-standing alopecia or thinning hair with significant actinic damage. The study found that even with clear margins achieved through Mohs micrographic surgery, 4 patients experienced recurrences and developed satellite lesions. The study recommends early diagnosis and treatment, suggesting wide excision with margin control, split-thickness grafting, and postoperative irradiation, while being cautious of osteoradionecrosis. Despite the aggressive treatment approach, which includes wide scalp resection, grafting, and possible radiation therapy, the mortality rate was high at 45.4%, and more than 40% of cases had wound healing complications post-radiation. The study underscores the need for early and aggressive treatment for SCCs of the scalp, especially in patients with alopecia and actinic damage.