title: Recalcitrant Invasive Skin Cancer of the Scalp: Combined Extirpation and Microsurgical Reconstruction Without Cranioplasty.
abstract: BACKGROUND
  Recurrent invasive skin cancer of the scalp and calvarium is a difficult problem for which universally accepted treatment protocols have not been established. The authors present their 10-year experience with treatment of this specific subset of scalp reconstruction patients and present a successful treatment algorithm that is well suited to this patient population.
  
  
  METHODS
  The authors retrospectively reviewed all patients of microsurgical scalp reconstruction performed from 2005 to 2015 that involved invasive cutaneous malignancies of the scalp and calvarium.
  
  
  RESULTS
  Eleven patients met inclusion criteria. There were 9 squamous cell carcinoma, 1 basal cell carcinoma, and 1 melanoma. Seven received radiation prior to resection, 2 were irradiated postoperatively, and 2 were immunosuppressed. Seven had a history of prior scalp reconstruction. The median scalp defect size was 141 cm. All the patients underwent craniectomy and the median cranial defect size was 71 cm. Cranioplasty was not performed in any patient. There were no intraoperative complications or flap loss. Recipient site complications included hematoma in 1, 1 seroma, 2 cerebral spinal fluid leaks, 3 partial skin graft loss. There was 1 donor site seroma in a patient who had a latissimus dorsi flap. All the patients reported satisfaction with the overall result and none were limited in activities by the existing cranial defect.
  
  
  CONCLUSIONS
  This is the largest series published to date that focuses exclusively on management of cutaneous malignancies with intracranial invasion. Wide resection with craniectomy, and reconstruction with microvascular free tissue transfer without cranioplasty provides safe and reliable treatment of recalcitrant invasive scalp skin cancers with low morbidity and without major complications. Pre and postoperative radiation is well tolerated with this approach. The patients in this series were of advanced age and of a lifestyle for which cranioplasty is unnecessary for return to regular activities.
authors.affiliation: *Division of Plastic and Reconstructive Surgery, Department of Surgery †Department of Neurological Surgery, University of California San Francisco, San Francisco, CA.
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Cho
authors.forename: Frederick
authors.initials: F
authors.lastname: Wang
authors.forename: Steven M
authors.initials: SM
authors.lastname: Garcia
authors.forename: Jennifer
authors.initials: J
authors.lastname: Viner
authors.forename: William Y
authors.initials: WY
authors.lastname: Hoffman
authors.forename: Michael W
authors.initials: MW
authors.lastname: McDermott
authors.forename: Jason H
authors.initials: JH
authors.lastname: Pomerantz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003399:Craniotomy; D062109:Dermatologic Surgical Procedures / Q000379:methods*; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012535:Scalp / Q000601:surgery*; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D012886:Skull / Q000601:surgery*; D013524:Surgical Flaps / Q000009:adverse effects