Malignant neoplasms of the scalp. Etiology, resection, and reconstruction.

Malignant scalp neoplasms initially spread by radial extension with deep invasion occurring relatively late in the course of disease. Basal cell carcinomas have the highest incidence followed by squamous cell carcinomas and melanomas. Surgical excision provides the best chance of cure in the majority of cases. Tumor histology influences decisions about margins of resection and regional lymph node dissection. Primary closure usually can be obtained for scalp defects measuring up to 3 cm in diameter. Larger defects can be reconstructed with skin grafts, local flaps, musculocutaneous flaps, free flaps, or transposition flaps following tissue expansion.