Curative Radiotherapy for Locally Advanced Scalp Squamous Cell Carcinoma.

Area of Science:

• Oncology
• Radiation Oncology

Background:

• Squamous cell carcinoma (SCC) of the scalp can present as locally advanced disease.
• Surgical intervention is often the primary treatment for T4 SCC, but patient refusal necessitates alternative strategies.

Observation:

• A 73-year-old male presented with a large, ulcerative, moderately differentiated squamous cell carcinoma on the scalp vertex with skull erosion.
• The patient declined both surgical intervention and medical treatment initially.
• Imaging revealed a fungating mass with skull erosion but no intracranial extension or distant metastasis.

Findings:

• The patient received high-dose radiotherapy using volumetric-modulated arc therapy (VMAT) to 60 Gy over six weeks.
• Three months post-radiotherapy, a significant skin defect was noted, but there was no evidence of clinical invasive disease.
• At three years of follow-up, the patient remained clinically disease-free.

Implications:

• High-dose radiotherapy (VMAT) can be an effective definitive treatment for unresectable or refused-surgery T4 squamous cell carcinoma of the scalp.
• This case highlights radiotherapy as a viable alternative for patients with locally advanced SCC who are unwilling or unable to undergo surgery.
• Further research into high-dose radiotherapy protocols for advanced cutaneous malignancies is warranted.