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Giant Adenoid Basal Cell Carcinoma of the Scalp with Intracranial Involvement – Composite Resection and Single Stage Reconstruction
Amy Hiuser MD, Graham Schwarz MD
Cleveland Clinic General Surgery
Hospital based training program
2012-02-15
Presenter: Amy Hiuser
Affidavit:
Entire write up done by resident with editing assistance from staff.
Director Name: Dr A Siperstein
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: General Reconstruction
How does this presentation meet the established conference educational objectives?
This presentation provides an indepth example of a multidisciplinary approach to a complex case. Not only is this basal cell carcinoma unique in its pathology and size which provides excellent educational points. It also demonstrates a complex immediate reconstruction using free flap with a remarkable outcome.
How will your presentation be used by practicing physicians in the audience?
This presentation will be an case of interest of a rare basal cell carcinoma. It will also demonstrate how immediate reconstruction can occur in the setting of an extensive defect. Also, this case shows how a multidisciplinary approach to a complex case provides exceptional outcomes.
Adenoid basal cell carcinoma (BCC) is a rare, but aggressive, histologic subtype of this otherwise common cutaneous malignancy. The clinical categorization of "giant" is introduced when a BCC is greater than 5cm (American Joint Committee on Cancer).
We present a 72 year old female nurse with UV exposure in childhood with a neglected, giant, fungating BCC of the scalp, right ear and occipital bone. Preoperative biopsy revealed adenoid, infiltrating and nodular components within the tumor. Dural invasion was noted on preoperative imaging and a multidisciplinary approach was planned. 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 and STSG using the right superficial temporal artery and vein as recipient vessels. PET avid and clinically enlarged level V cervical nodes were biopsied and negative of disease. 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.
The patient's hospital course was uneventful and she was discharged with local wound care. Adjuvant external beam radiation was initiated 8 weeks postoperatively.
To our knowledge, this is the only reported case of a giant, locally invasive scalp BCC, adenoid subtype treated with composite resection and single stage reconstruction.
