Squamos cell carcinoma of the scalp with intracranial extension - importance of various imaging modalities

Abstract

Introduction. Around 2% of all cutaneous neoplasms arise in the scalp and can be classified as either primary or metastatic. Intracranial extension is rare in cutaneous malignancies, but can generally occur if left untreated. Squamos cell carcinoma (SCC) is the second most common type of nonmelanoma skin cancer after basal cell carcinoma. About 3-8% of SCCs are located on the scalp and can cause skull and dural invasion in rare cases. Case report. A 49-year old male patient presented with a large and painful lesion in the parieto-occipital region of the head. MRI revealed a large inhomogeneous, necrotic lesion with infiltration of the underlying skull and dura. The patient underwent surgical removal of the tumor with excision of invaded skin, bone and dura with a safety margin of 1 cm followed by custom prefabricated three-dimensional printed cranioplasty with polymethylmetacrilate (PMMA). Histopathological analysis revealed invasive squamous cell carcinoma with immunohistochemistry staining revealing CK5/6 and CK7 positivity. Conclusion. Some cases of scalp SCCs can cause invasion of the underlying skull and dura if left untreated. Imaging modalities like computed tomography (CT) and magnetic resonance imaging (MRI) play a crucial role in evaluating the degree of neoplastic extension and potential calvarial and dural invasion, thus being of significant importance in preoperative planning and management.