[Surgical management of squamous-cell carcinomas arising in burn scar of the scalp].

A series of seven patients with squamous-cell carcinoma that arose in the area of an old scalp burn is presented, and the patient's profiles, surgical procedures and results are reviewed. In six patients, burn scar of the scalp caused by direct exposure to fire in their infancy was a pathogenesis underlying the development of the malignancy, and the time interval was estimated to be an average of 53 years. In five patients there was evidence of intracranial invasion of the carcinoma involving the dura mater and cerebral parenchyma, as revealed by neuroradiological examinations and surgery. All patients were treated by extensive excision of the lesion, and to cover defects of the scalp and cranium, a variety of reconstructive techniques were used involving advancement, transposition or free latissimus dorsi musculocutaneous flaps combined with microvascular anastomosis. Radiochemotherapy was undertaken additionally in some patients either before or after surgery. Complete excision was accomplished in two patients, in whom the carcinoma was found localized within the layer of the scalp or in the depth of the periosteum. The survival time in these patients ranged from 73 to 87 months. In contrast, incomplete resection was performed in the remaining five patients, in whom the dura mater had been invaded with simultaneous involvement of the middle part of the superior sagittal sinus. The outcome resulted in poor prognosis, and all the patients except one died in 9 to 24 months after surgery due to continuous growth of the tumor in the intracranial cavity. Therefore, total resection facilitated by early detection prior to intracranial invasion is mandatory for successful treatment of such scalp carcinomas.