Abstract and Introduction
Abstract
Introduction: Squamous cell carcinoma (SCC) is the second most prevalent malignant skin carcinoma. Bone infiltration is uncommon, and invasion of the dura mater and brain parenchyma is rare and possible only in the advanced stages of the disease. Treatment of advanced SCC is challenging and often requires the collaboration of a multidisciplinary team to provide local and systemic treatment. Management of advanced SCC of the scalp involving bones and meninges with brain exposure was described herein.
Case Report: An 85-year-old male presented with advanced SCC of the scalp. A vegetative and infiltrating neoplastic ulcer of the frontal and parietal regions with exposure of the brain and extensive meningeal and bone destruction was observed. Because of comorbidities and decisions made by the patient and his family, he did not undergo immunotherapy, radiotherapy, or other invasive treatments. The neoplastic tissue was covered by blood, fibrin, and bacterial colonization. The patient received palliative care in a wound healing clinic twice monthly for 1 year, and daily dressing changes were performed at home. Binding bacteria dressings, silver dressings, and absorbent dressings were used to control exudate and infection. Alginate was used to manage bleeding, and charcoal dressings were used to manage odor. The dressings were covered with gauze and bandage. Additionally, swabs were performed when signs of infection were present and targeted systemic antibiotic treatment administered.
Conclusions: Squamous cell carcinoma rarely presents with a devastating and rapid evolution. In this case, the local approach was based on the TIME (tissue, inflammation/infection, moisture imbalance, epithelial edge advancement) concept, with special attention paid to the most significant features of neoplastic wounds (eg, pain, exudate, bleeding, odor). Despite the patient's serious conditions, he survived for a relatively long time.
Introduction
Squamous cell carcinoma (SCC) is the second most prevalent malignant skin carcinoma.[1] It generally occurs in older patients, and the head and neck are the most common location.[1] The precise incidence is unknown, but it has increased in recent years.[2] A recent study reported an incidence of advanced SCC of approximately 2.1%.[3] Surgery is the first-line treatment, followed by radiotherapy and systemic therapies. Accurate prognosis in the early stages is possible; a 5-year survival rate of 90% has been reported.[4] Currently, cemiplimab is the systemic therapy indicated for inoperable advanced SCC or metastatic SCC.[5] Bone infiltration is uncommon, and invasion of the dura mater and brain parenchyma is rare and occurs only in advanced stages. Management of advanced SCC is challenging and often requires the collaboration of a multidisciplinary team to provide local and systemic treatment.[6,7] The current case report described advanced SCC of the scalp involving bones and meninges with brain exposure.
Wounds. 2022;34(1):E7-E9. © 2022 HMP Communications, LLC
