Lang Pearon G, Braun Martin A, Kwatra Rajiv
Department of Dermatology, Medical University of South Carolina, Charleston, SC 29425, USA.
Dermatol Surg. 2006 Sep;32(9):1163-70. doi: 10.1111/j.1524-4725.2006.32258.x.
Squamous cell carcinomas of the scalp sometimes exhibit unusually aggressive behavior.
To describe a series of 11 cases of extraordinarily aggressive squamous cell carcinomas of the scalp.
These cases were selected based on a number of criteria including their tendency to recur after Mohs surgery, their propensity to develop satellite lesions, their tendency to invade bone, and their tendency to metastasize to regional nodes and systemically. A chart review was performed for each patient.
Five of 11 patients have succumbed to their disease. Of note is that the patients all had significant long-standing alopecia or thinning of their hair with marked actinic damage. Initial biopsies of the tumors revealed them to be either moderate or well-differentiated. Four of 11 patients developed satellite lesions and experienced recurrences despite obtaining clear margins with Mohs micrographic surgery.
Squamous cell carcinomas of the scalp may metastasize and cause death. Thus, early diagnosis and treatment of these neoplasms is mandatory. In the setting of satellitosis, it is believed that it is best to perform a wide excision with margin control followed by split-thickness grafting and postoperative irradiation. The employment of radiation therapy, however, should be done with appropriate caution owing to the significant risk of osteoradionecrosis.
头皮鳞状细胞癌有时表现出异常侵袭性的行为。
描述一系列11例具有极强侵袭性的头皮鳞状细胞癌病例。
这些病例是根据一些标准挑选出来的，包括Mohs手术后复发的倾向、出现卫星病灶的倾向、侵犯骨质的倾向以及转移至区域淋巴结和全身的倾向。对每位患者进行了病历回顾。
11例患者中有5例死于该病。值得注意的是，这些患者均有显著的长期脱发或头发稀疏，并伴有明显的光化性损伤。肿瘤的初次活检显示其为中度或高分化。11例患者中有4例出现卫星病灶，尽管Mohs显微外科手术切缘清晰，但仍复发。
头皮鳞状细胞癌可能发生转移并导致死亡。因此，这些肿瘤的早期诊断和治疗至关重要。在卫星灶形成的情况下，最好进行广泛切除并控制切缘，随后进行中厚皮片移植和术后放疗。然而，由于发生放射性骨坏死的风险很高，放疗的应用应谨慎。
