High risk squamous cell carcinoma

Mrs MA, 70 years of age, has a history of scalp psoriasis dating over 10 years. She explained that the rash was slowly progressing and had failed to respond to an array of topical treatments offered. Within the right lateral aspect of the 12 x 14 cm lesion a thick nodule had recently developed. It looked like squamous cell carcinoma (SCC). Biopsy of the raised lesion confirmed SCC as did four other biopsies at the poles of the region of 'psoriasis'. Removing all surface debris confirmed this was one confluent scalp tumour. The large scalp SCC was excised with a 5 mm margin. During surgery there was an area of apparent involvement of galea. This layer was widely excised along with periosteum at that point. Histology confirmed complete excision. There was no other point at which deep levels were involved. Periosteum was not involved. The large defect was closed with a partial thickness skin graft harvested from the right anterior thigh.