Background and objectives: Early detection and good loco-regional control is essential for success in surgical management of cutaneous malignancy. In the scalp, the ability to achieve adequate deep marginal clearance can sometimes offer a challenge due to local anatomy (scalp–calvarium junction). This becomes more relevant with increased tumour thickness/depth of invasion.

Methods: Retrospective review of medical records: 115 consecutive patients with histological diagnosis of scalp squamous cell carcinoma who were treated with primary surgery from 2005 to 2012. Data collection: patient demography, surgical pathology, reconstruction of defects, regional recurrence and follow-up duration. Results (main findings): Median age 80.7 years (IQR 76-85.4). Gender distribution: 102 (89%) male and 13 (11%) female. Median follow-up 23.5 months (IQR 8.2-42.3). Overall regional recurrence rate in this cohort was 4.3% (5/115). Forty-six patients (40%) required local flaps and 63 (55%) had skin grafts, to reconstruct the ablative surgical defects. In six patients (5%), the wounds were closed primarily. Tumour differentiation*: 29 well (28%), 56 moderate (55%) and 17 poor (17%). Tumour thickness*: <4 mm in 20 (33%) patients and >4 mm in 41 (67%) patients; regional recurrence 10% (4/41) vs 0. Deep margin*: <1 mm in 33 (30%) patients and >1 mm in 76 (70%) patients; regional recurrence rates 12% (4/33) vs 0.01% (1/76). *only patients with completed dataset included.

Conclusions: The overall regional recurrence rate in this cohort was within the 5% risk generally accepted for cutaneous head and neck malignancy. The risk factors identified for development of regional parotid/neck recurrence include tumour thickness >4 mm and deep marginal clearance <1 mm. This high risk group of patients should be selected to undergo more intensive follow-up programme by means of ultrasound surveillance. Although the role of sentinel node biopsy is still unproven, this should be a consideration in the context of a clinical trial.

Key words: scalp cancer; skin cancer; squamous cell carcinoma

Conflict of interest: None declared.