title: Cutaneous squamous cell carcinoma of the scalp in the immunocompromised patient: review of 53 cases.
abstract: OBJECTIVE
  We analyzed outcomes from immunocompromised patients with scalp squamous cell carcinoma (SCC) treated with surgical excision with and without radiation in order to explore 3-year disease-free survival and overall survival.
  
  
  METHODS
  The study design was a retrospective chart review.
  
  
  METHODS
  This study was conducted in a private practice setting.
  
  
  METHODS
  The study included 53 immunocompromised patients with an average age of 63.2 years, with scalp squamous cell carcinoma. Pre-operative imaging dictated the extent of resection. Patients with bony involvement received wide local excision including full-thickness craniectomy and cranioplasty. Patients without bony involvement underwent wide local excision and outer-table calvarial resection. All patients were recommended to have post-operative radiation. Patients were followed for a minimum of 3 years.
  
  
  RESULTS
  A total of 53 patients were included in the study. Six patients had pre-operative CT showing bone involvement and were treated with full-thickness craniectomy along with post-operative radiation. Fourteen patients without bone involvement on pre-operative CT were found to have positive bone involvement on final pathology. Forty-five patients underwent post-operative radiation. Patients treated with adjuvant radiation demonstrated a 3-year survival of 80 % and the overall survival was 62 %. In the surgery-only group, the 3-year survival was 62.5 % and the overall survival was 32.5 %.
  
  
  CONCLUSIONS
  Immunocompromised patients with scalp SCC have a poor prognosis. Early detection and treatment are crucial. Based on our results, we recommend wide local excision with at least outer-table calvarial resection, and post-operative radiation. Despite aggressive therapy, patients may still have distant, local, or regional recurrence.
  
  
  METHODS
  level 2b (retrospective cohort).
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.
authors.forename: Sameep
authors.initials: S
authors.lastname: Kadakia
authors.affiliation: Otolaryngology and Facial Plastic Surgery Associates, 923 Pennsylvania Avenue Suite 100, Fort Worth, TX, 76104, USA. yducic@sbcglobal.net.
authors.forename: Yadranko
authors.initials: Y
authors.lastname: Ducic
authors.affiliation: Mohs Private Practice, Dallas, TX, USA.
authors.forename: Diego
authors.initials: D
authors.lastname: Marra
authors.affiliation: Otolaryngology and Facial Plastic Surgery Associates, 923 Pennsylvania Avenue Suite 100, Fort Worth, TX, 76104, USA.
authors.forename: David
authors.initials: D
authors.lastname: Chan
authors.affiliation: Otolaryngology and Facial Plastic Surgery Associates, 923 Pennsylvania Avenue Suite 100, Fort Worth, TX, 76104, USA.
authors.forename: Masoud
authors.initials: M
authors.lastname: Saman
authors.affiliation: Department of Facial Plastic Surgery, University of Florida, Gainesville, FL, USA.
authors.forename: Raja
authors.initials: R
authors.lastname: Sawhney
authors.affiliation: Otolaryngology and Facial Plastic Surgery Associates, 923 Pennsylvania Avenue Suite 100, Fort Worth, TX, 76104, USA.
authors.forename: Moustafa
authors.initials: M
authors.lastname: Mourad
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000276:immunology* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003399:Craniotomy; D005500:Follow-Up Studies; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000276:immunology* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009361:Neoplasm Invasiveness; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012535:Scalp / Q000276:immunology*; D012878:Skin Neoplasms / Q000276:immunology* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012888:Skull Neoplasms / Q000276:immunology* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
keywords: Carcinoma; Cutaneous; Immunocompromised; Scalp; Squamous