Romano Lucia, Caponio Chiara, Vistoli Fabio, Lupi Ettore, Fargnoli Maria Concetta, Esposito Maria, Lancione Laura, Bellobono Manuela, Hassan Tarek, Iacobelli Elisabetta, Semproni Luca, Panarese Alessandra
Department of General and Transplant Surgery, San Salvatore Hospital, ASL1 Abruzzo, Coppito, 67100 L'Aquila, Italy.
UOSD of General and Oncological Dermatology, San Salvatore Hospital, ASL1 Abruzzo, Coppito, 67100 L'Aquila, Italy.
Cancers (Basel). 2025 Mar 26;17(7):1113. doi: 10.3390/cancers17071113.
Organ transplant recipients are at a significantly higher risk of developing skin cancer compared to the general population, particularly cutaneous squamous cell carcinoma. Approximately 3-8% of these carcinomas are located on the scalp. Scalp reconstruction is particularly challenging, especially for large excisions, due to the thickness of the scalp, the inelastic aponeurosis of the galea, and the integrity of the hair-bearing scalp. Additionally, in organ transplant recipients, the presence of numerous comorbidities and the increased risk of infection due to immunosuppressive therapy make management more complex. Based on our experience and the existing literature, we aim to describe possible reconstruction methods and discuss the combined management of medical and immunosuppressive therapy.
We present our experience with seven kidney transplant patients who underwent excision of cutaneous squamous cell carcinoma with a diameter larger than 3 cm. The crane technique involves three key steps. First, the tumor is excised with wide margins of disease-free tissue. Next, a pericranial flap is rotated and positioned to cover the exposed cranial bone. Finally, a bilayer dermal substitute is applied to create a microenvironment that supports skin graft implantation.
The crane technique was used for six patients. In one case, an O-Z rotation flap was used. All patients modified their immunosuppressive therapy, with those receiving antiproliferative therapy switching everolimus after surgery.
When combined with a post-operative modification of the immunosuppressive regimen, the crane technique could be considered a feasible, safe, and effective approach to managing large cSCC of the scalp in fragile patients.
与普通人群相比，器官移植受者患皮肤癌的风险显著更高，尤其是皮肤鳞状细胞癌。这些癌症中约3 - 8%位于头皮。由于头皮厚度、帽状腱膜的无弹性腱膜以及有毛发头皮的完整性，头皮重建尤其具有挑战性，特别是对于大面积切除。此外，在器官移植受者中，多种合并症的存在以及免疫抑制治疗导致的感染风险增加使管理更加复杂。基于我们的经验和现有文献，我们旨在描述可能的重建方法，并讨论医学治疗和免疫抑制治疗的联合管理。
我们介绍了7例肾移植患者的经验，这些患者接受了直径大于3 cm的皮肤鳞状细胞癌切除术。鹤式技术包括三个关键步骤。首先，切除肿瘤并带有无病组织的宽切缘。其次，旋转并定位帽状腱膜瓣以覆盖暴露的颅骨。最后，应用双层真皮替代物以创建支持皮肤移植植入的微环境。
6例患者使用了鹤式技术。1例使用了O - Z旋转皮瓣。所有患者都调整了免疫抑制治疗，接受抗增殖治疗的患者术后改用依维莫司。
当与免疫抑制方案的术后调整相结合时，鹤式技术可被认为是一种可行、安全且有效的方法，用于治疗脆弱患者头皮的大面积皮肤鳞状细胞癌。
