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Intracranial Invasion of a Basal Cell Carcinoma of the Scalp

Published online by Cambridge University Press:  02 December 2014

David Mathieu  and
David Fortin
David Mathieu
Affiliation:
Department of Neurosurgery/Neuro-Oncology, Centre Hospitalier Universitaire de Sherbrooke, Universite de Sherbrooke, Sherbrooke, Canada
David Fortin*
Affiliation:
Department of Neurosurgery/Neuro-Oncology, Centre Hospitalier Universitaire de Sherbrooke, Universite de Sherbrooke, Sherbrooke, Canada
*
Centre Hospitalier Universitaire de Sherbrooke (CHUS), 3001 12e avenue Nord, Sherbrooke, Quebec J1H 5N4 Canada
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Abstract:

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Objective and importance:

Basal cell carcinomas are common lesions that can have a locally invasive behavior. The authors present a case of a scalp lesion with skull and dura-mater invasion that was unrecognized prior to surgical undertaking.

Clinical presentation:

A 66-year-old female presented with an extensive ulcerating lesion on the frontal scalp, deemed to be a basal cell carcinoma. The plastic surgery team brought her to the operating room for resection but subsequently backed off after the discovery of bony invasion. Imaging revealed extensive bony and epidural extension.

Intervention:

Resection of the invaded frontal scalp, bone, dura-mater and proximal part of the superior sagittal sinus was performed. This was followed by a reconstructive procedure consisting of a duraplasty, a cranioplasty, and a skin rotation flap and partial-thickness skin grafting.

Conclusion:

Radiological evaluation of scalp basal cell carcinomas should be done prior to surgery to rule out any bony or intracranial invasion.

Résumé:

RÉSUMÉ:Objectif et importance:

Le carcinome basocellulaire est une lésion fréquente dans laquelle on peut observer un envahissement local. Les auteurs présentent un cas de lésion du cuir chevelu avec envahissement du crâne et de la dure-mère qui n’avait pas été soupçonné avant la chirurgie.

Observation clinique:

Une patiente âgée de 66 ans a consulté pour une ulcération importante à la région frontale du cuir chevelu chez qui on a posé un diagnostic de carcinome basocellulaire. L’équipe de chirurgie plastique a interrompu l’exérèse de la lésion après avoir constaté en salle d’opération son extension à l’os. L’imagerie a montré une extension importante de la tumeur à l’os et à la dure-mère.

Intervention:

On a procédé à une résection de la région envahie par la tumeur au niveau du cuir chevelu, de l’os, de la dure-mère et de la partie proximale du sinus longitudinal supérieur. Par la suite, la patiente a subi une chirurgie de reconstruction, soit une dura plastie, une cranioplastie et la mise en place d’un lambeau cutané de rotation ainsi que d’un greffon de peau mince.

Conclusion:

On devrait procéder à une évaluation radiologique des carcinomes basocellulaires du cuir chevelu avant la chirurgie pour éliminer la possibilité qu’il existe un envahissement osseux ou intracrânien.

Type
Case Report
Information
Canadian Journal of Neurological Sciences , Volume 32 , Issue 4 , November 2005 , pp. 546 - 548
Copyright
Copyright © The Canadian Journal of Neurological 2005

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