Scalp Basal Cell Carcinoma: A Different Entity?

The document reviews scalp basal cell carcinoma (BCC), highlighting its unique clinical and pathological characteristics, risk factors, and treatment challenges. It emphasizes that scalp BCC may be more aggressive and difficult to treat than BCC in other locations, potentially due to the scalp's high number of pilosebaceous follicles, protection from UV exposure, and other host-related factors or the irradiated environment. The nodular subtype is the most common histological form of scalp BCC, with a significant recurrence rate of 12-25% for primary tumors. Genetic studies, such as those by Tessone et al., found no differences between scalp BCCs from irradiated and non-irradiated patients, suggesting other factors contribute to their aggressiveness. Treatment options include surgery, with Mohs micrographic surgery having a 5.7% recurrence rate after 5 years, and Vismodegib for advanced cases. The document concludes that the potential aggressiveness and difficulty in treatment of scalp BCCs warrant special consideration, and it calls for further research into their distinct nature.