title: Aggressive squamous carcinomas of the scalp.
abstract: BACKGROUND
  Squamous cell carcinomas of the scalp sometimes exhibit unusually aggressive behavior.
  
  
  OBJECTIVE
  To describe a series of 11 cases of extraordinarily aggressive squamous cell carcinomas of the scalp.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Dermatology, Medical University of South Carolina, Charleston, SC 29425, USA. langpg@musc.edu
authors.forename: Pearon G
authors.initials: PG
authors.lastname: Lang
authors.forename: Martin A
authors.initials: MA
authors.lastname: Braun
authors.forename: Rajiv
authors.initials: R
authors.lastname: Kwatra
mesh_terms: D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015580:Mohs Surgery; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012535:Scalp; D012720:Severity of Illness Index; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery