Iintroduction: scalp’s carcinomas are most of times squamous cell carcinomas or Basal cell carcinomas. If we neglect those tumors, they would quickly grow and evade the calvarium, the dura, and even the celebral tissue. We define as an advanced carcinoma, every Carcinoma which size exceeds 7 cm and/or reaches bones or any intracranial Tissue.The purpose of this present study was to restore, through a retrospective study, the epidemiological and clinical aspects of the concerned tumors, and to measure as well the difficulties we meet in our department when dealing with such advanced cases therapy.
Patients and Methods: In order to surround better those cases, we opted for a retrospective study that included 09 patients all touched by advanced scalp’s carcinomas. They all have been operated in the ENT department and neck surgery in Omar Drissi’s hospital and the hospital of specialties in the University health center Hassan II .
Results: The middle age of our patients was 65.1 years old with a sex ratio of M/W=3. The evolution had already started before consultation averagely 39.6 months. the tumor’s locations were mainly parietal (4 cases) .6 of the carcinomas cases were squamous cell carcinomas Versus 2 which were basal cell carcinomas. Only one case turned to be an adenoid cystic carcinoma. 2 cases presented cervical lymphadenopathies. Bone involvement was found in 5 of the cases (3 at the TDM and 2 during the surgical exploration or at the histological exams). The initial carcinological excision was complete in 7 of 9 cases. The reconstructives techniques which we used were mainly the total skin draft (2 patients), and the local transposition flaps (for the 7 left) with an associated rotation flap in one case. In 3 cases, the association of two flaps was necessary because of the defect size. Two cranioplasties with acrylic cement were done. The evolution was marked by a recurrence in one case, a parotid metastasis in another, and death in a third one
Discussion and conclusion:advanced scalp’s carcimas can be classified in the high risk of reccurence group. Plastic surgery has a double benefit in such malignants scalp tumors: It allows the carcinological excision of tumors, and the coverage of defects as well. This can be rebuilt securely with local flaps on scalp left. This reconstruction needs essentially transposition flaps. A skin graft can be only possible if the periosteum is preserved. if it’s not the cases it can be done only after getting a granulation tissue. As for immediat and differed cranioplaties, they are still the subject of many discussions in literature