Article review: Management of Squamous Cell Carcinoma of the Scalp

This month I have selected a paper from the recent Australasian Journal of Dermatology, reporting on outcomes of patients with squamous cell carcinoma of the scalp. This is the largest cohort of patients with this condition reported in the literature. Of course the Peter MacCallum Cancer Centre is a tertiary referral centre and so we would expect these patients to have more serious and advanced disease than an unselected primary care cohort. Nevertheless, this paper serves to remind us how serious SCC, especially on the scalp, is. Although most patients did well, local relapse was not uncommon and a few patients developed metastatic disease.

For those of us working in primary care, we are reminded that SCC is a serious condition, that should be treated promptly and excision assured. Patients with scalp SCC should be followed up carefully and referred for specialist review if any recurrence is suspected.

The Abstract of this paper is copied below.

“Outcomes following management of squamous cell carcinoma of the scalp: A retrospective series of 235 patients treated at the Peter MacCallum Cancer Centre”

Vanessa Estall,1,2 Angela Allen,3 Angela Webb,4 Mathias Bressel,4 Chris McCormack4 and John Spillane2,4
1Liverpool Hospital Cancer Therapy Centre, Sydney, New South Wales , 2University of Melbourne, Melbourne,Victoria, Australia, 3Waikato Regional Cancer Centre, Hamilton, New Zealand, and 4Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

ABSTRACT

Background: Squamous cell carcinoma of the scalp is a common clinical problem in an aging population. Despite its high incidence, little has been documented regarding treatment or outcomes.

Methods: We retrospectively analysed 235 cases treated with curative intent at Peter MaCallum Cancer Centre between 1998 and 2010. The cohort was analysed for its characteristics, management, survival and prognostic factors.

Results: The patients were primarily male (88%) with a median age of 79 years (range 53–98 years). There was a high proportion of immunosuppressed patients (29%) and stage T2 (48%) tumours. Management included surgery (45%), radiotherapy (28%) and surgery and adjuvant radiotherapy (26%). Median follow up from treatment was 4.5 years. Estimated 5-year overall survival (OS), disease-specific survival and progression-free survival (PFS) were 59, 94 and 51%, respectively. The 5-year cumulative incidence of local and regional relapse was 11 and 7%, respectively. There were four patients who developed distant metastases and died of their disease. Statistically significant prognostic factors identified for poor outcomes for OS and PFS were T2 stage (hazard ratio [1.7 and 2.1) and immunosuppression (HR 3.3 and 3.4).


Learn more about skin cancer medicine in primary care at the next Skin Cancer Certificate Courses:

Skin Cancer Certificate Courses in Australia

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