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A. Giant Adenoid Basal Cell Carcinoma of the Scalp with Intracranial Involvement – Review of a Rare Entity and Successful Management Strategies
Amy Hiuser MDa, Melissa Piliang MDb Graham S. Schwarz MD c
University
2013-02-28
Presenter: Amy Hiuser
Affidavit:
The resident wrote the majority of the paper with attending assistance in editing.
Director Name: Dr Allan Siperstein
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: General Reconstruction
Adenoid basal cell carcinoma (BCC) is a rare, but potentially aggressive, histologic subtype of this otherwise common cutaneous malignancy.
We present a 72 year old female, with a history of medicinal UV light treatment in childhood, with a neglected, fungating, giant BCC of the scalp, right ear and occipital bone. Preoperative biopsy revealed predominantly adenoid histology with additional infiltrating and nodular components within the tumor. Workup for distant metastatic disease was negative. The patient underwent radical resection of the biparietal and occipital scalp, right auriculectomy and occipital craniectomy with dural resection. Immediate reconstruction of the intracranial and bony defect was undertaken with dural substitute and a titanium cranioplasty. The 35 cm x 25 cm soft tissue defect was reconstructed with a latissimus dorsi muscle microvascular free flap with a split thickness skin graft using the right superficial temporal artery and vein as recipient vessels. Postoperative pathology confirmed the diagnosis of adenoid BCC with perineural invasion. As expected, bony margins were positive due to the proximity of the tumor to the dural sinuses.
Adjuvant external beam radiation was initiated 8 weeks postoperatively and successfully completed. Fourteen months following initial presentation the patient is disease free.
To our knowledge, this is the only reported case of a giant, locally invasive scalp BCC with the adenoid subtype treated with composite resection and single stage reconstruction. We present our management strategy and a review of the literature on this seldom reported entity.
