Rare, Locally Advanced Presentation of Giant Scalp Squamous Cell Carcinoma: A Case Report

Giant cutaneous squamous cell carcinoma (cSCC) of the scalp is rare and presents significant therapeutic challenges due to its size, proximity to critical neurovascular structures, and complex reconstructive requirements. We report a 68-year-old woman with a 20 cm exophytic occipito-parietal cSCC that had been evolving over one year. Biopsy confirmed a well-differentiated cSCC, and imaging revealed a heterogeneous mass abutting the skull without nodal or distant metastases. The tumor was managed with wide surgical excision, including the cranial periosteum and outer table curettage, followed by staged reconstruction using pedicled transposition flaps and split-thickness skin grafts. Histopathology confirmed a well-differentiated infiltrative cSCC (T3N0M0, American Joint Committee on Cancer (AJCC) stage III) with clear margins. Postoperative outcomes were satisfactory, both functionally and aesthetically. This case underscores the importance of early detection, multidisciplinary management, and individualized surgical planning in giant scalp cSCC, with adjuvant therapies offering additional options for advanced disease.