Squamous Cell Carcinoma of Scalp: Our Experience in a Single Tertiary Care Centre

Cutaneous cancer is a rare entity accounting for less than 1% of all diagnosed cancers in India. In contrast to the West, squamous cell carcinoma is the commonest skin cancer in India, often affecting the scalp. However, due to their rarity, not much is known regarding their biological behavior and prognosis. The present study is a retrospective cohort study undertaken in a tertiary cancer centre on 19 consecutive cases of squamous cell carcinoma of the scalp over a period of 5 years. Patients with non-sqamous histology and those associated with xeroderma pigmentosum were excluded. Nineteen patients were evaluated with a mean age of 52.7 years. Majority presented with a swelling (11 patients; 57.9%) in the parieto-occipital region (13 patients; 68.4%). All patients underwent wide excision with or without excision of underlying bone or dura, depending on involvement. Only 4 (21%) required major reconstruction. On histopathology, 8 (42.1%) were poorly differentiated, while 3 (15.8%) had presence of perineural invasion (PNI). The mean duration of follow-up was 38.14 months. Three of the 4 (75%) and 2 of 3 (66.67%) patients with poorly differentiated histology and PNI respectively developed recurrence, while only 1 of the 6 (16.67%) with close or positive base margin developed recurrence. Hence, to conclude, poorly differentiated histology and PNI are poor prognostic indicators, while in the event the mucoperiosteum is clinically uninvolved, the underlying bone may be preserved in select cases, even if the base margin is close.