Sameep Kadakia1, Yadranko Ducic2, Diego Marra3, David Chan4, Masoud Saman4, Raja Sawhney5, Moustafa Mourad4. 1. Department of Otolaryngology-Head and Neck Surgery, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA. 2. Otolaryngology and Facial Plastic Surgery Associates, 923 Pennsylvania Avenue Suite 100, Fort Worth, TX, 76104, USA. yducic@sbcglobal.net. 3. Mohs Private Practice, Dallas, TX, USA. 4. Otolaryngology and Facial Plastic Surgery Associates, 923 Pennsylvania Avenue Suite 100, Fort Worth, TX, 76104, USA. 5. Department of Facial Plastic Surgery, University of Florida, Gainesville, FL, USA.
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. STUDY DESIGN: The study design was a retrospective chart review. SETTING: This study was conducted in a private practice setting. SUBJECTS AND 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. LEVEL OF EVIDENCE: level 2b (retrospective cohort).
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. STUDY DESIGN: The study design was a retrospective chart review. SETTING: This study was conducted in a private practice setting. SUBJECTS AND 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. LEVEL OF EVIDENCE: level 2b (retrospective cohort).
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