Calvarial Burring in Management of Cutaneous Squamous Cell Carcinoma of the Scalp Without Calvarial Involvement

Introduction: Squamous cell carcinoma of the scalp (sSCC) has been shown to have a poorer prognosis than other head and neck subsites. The aim of this study was to investigate oncologic and postoperative outcomes in patients with sSCC with periosteal involvement and the clinical utility in calvarial burring.

Methods: A retrospective cohort study was completed between 2010 to 2024. Inclusion criteria consisted of patients with sSCC with periosteal involvement on pathology without gross bony involvement. Data collected consisted of demographics, disease presentation, surgical approach, and postoperative and oncologic outcomes. Statistical significance was defined as p-value <.05.

Results: We identified 23 patients with sSCC with periosteal involvement on pathology. Average age was 72 (SD 11), 83% were male, and 39% were immunosuppressed. Seven (30%) cases had excision of involved periosteum as the deepest plane of resection, while 13 (57%) cases had burring of the outer table as the deepest plane of resection. Resection of the outer table occurred in 2 (9%) patients while full thickness calvarial resection occurred in 1 (4%). 11 (48%) patients received free flap reconstruction, while 3 (13%), 5 (22%), and 3 (13%) received a split thickness graft, rotational flap, and skin regeneration substitute, respectively. 10 (42%) were treated with adjuvant radiation after tumor resection. There was 1 local recurrence (33%) in the calvarial resection group, 4 (31%) local recurrences in patients who had calvarial burring, and 2 (28%) that had no burring (p-value:>0.05). There were 4 disease-related deaths.

Conclusions: sSCC with periosteal involvement is associated with high recurrence rates. Periosteal resection with calvarial burring or outer table resection appears to have no association with improved local control compared to resection of the periosteum alone.