Lo William B, Richmond Lewys, George K Joshi, Dardis Ronan
Department of Neurosurgery, University Hospital, Coventry, UK.
Br J Neurosurg. 2011 Oct;25(5):662-3. doi: 10.3109/02688697.2011.584985. Epub 2011 Jun 27.
This report describes a case of neglected scalp basal cell carcinoma (BCC) resulting in total destruction of soft tissue and underlying cranium, with remarkably preserved dura and no parenchymal involvement. A 57-year-old woman presented with a 2-week history of lethargy. On removal of her hat, a large round ulcer was revealed. It transpired that the patient noticed a pruritic scalp lesion 9 months ago. As the lesion and wound enlarged, she was too embarrassed to inform her family and hid it under a hat at all time. She never experienced meningitic symptoms. Biopsy confirmed BCC. Subsequently, she underwent two free latissimus dorsi flap reconstructions to cover the wound and palliative radiotherapy. She responded well to treatment. This case provides a rare opportunity to observe the natural history of scalp BCC. The reasons for the rarity of this mode of presentation and the low incidence of intracranial infection are discussed.
本报告描述了一例被忽视的头皮基底细胞癌（BCC）病例，该病例导致软组织和颅骨全层破坏，硬脑膜显著保留且无实质受累。一名57岁女性因嗜睡两周前来就诊。摘下帽子后，发现一个大的圆形溃疡。原来患者9个月前注意到头皮有瘙痒性病变。随着病变和伤口扩大，她因尴尬而未告知家人，一直用帽子遮盖。她从未出现过脑膜炎症状。活检确诊为基底细胞癌。随后，她接受了两次游离背阔肌皮瓣重建术以覆盖伤口并进行了姑息性放疗。她对治疗反应良好。该病例为观察头皮基底细胞癌的自然病程提供了难得的机会。文中讨论了这种表现方式罕见的原因以及颅内感染发生率低的原因。
