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PubMed2006

Intracranial recurrence of the scalp dermatofibrosarcoma.

We report a case of recurrent scalp dermatofibrosarcoma in a 30-year-old woman who underwent surgical intervention on three separate occasions during a 60-month period, and who received post-operative radiotherapy. A small, hard, elastic mass on the right parieto-occipital scalp was initially treated by simple resection in another clinic. Despite surgical intervention and radiotherapy, a recurrent tumor associated with infiltration to the calvarium was detected. The patient was then referred to our institution and a wide resection performed. Two years later, however, the patient was readmitted to our institution as a result of tumor recurrence with intracranial involvement. Scalp dermatofibrosarcoma is an uncommon but aggressive scalp tumor; therefore, wide local excision with good margins is essential to decrease the risk of regional recurrence. Close surveillance in these cases is necessary due to late tumor recurrences.

Adult↗

PubMed2006

Reconstruction of large defects on the scalp and forehead as an interdisciplinary challenge: experience in the management of 39 cases.

AIMS: To describe options and indications for different surgical reconstruction techniques after resection of large skin tumours on the scalp taking into account an interdisciplinary approach of cranio-maxillofacial surgeon, dermatologist, and neurosurgeon, and to evaluate complications and postoperative outcome. PATIENTS AND METHODS: From a total of 39 patients with large skin tumour resections on the scalp and/or the forehead, treated between January 01, 1995 and June 30, 2005, a number of 42 surgical reconstructions were performed. The medical histories, the surgical treatment, postoperative complications, follow-up and outcome were evaluated. RESULTS: The excision defects measured 146 cm(2) (range: 80.6-546 cm(2)) on average. The most common methods for defect closure were multiple rotation-advancement flaps (n=19). Six patients were treated with split-thickness skin grafts after bone drilling for inducing granulation tissue to grow. Free latissimus dorsi muscle flaps were used in 8 patients and radial forearm flaps in 4 cases. Postoperative complications were rare. An algorithm for the surgical approach to large scalp defects was developed. CONCLUSION: For reconstruction of large defects on the scalp and forehead, various reliable methods may be used with regard to individual patient-specific parameters in cooperation with different medical specialties involved.

Aged↗

PubMed2005

Scalp reconstruction.

The unique properties of the human scalp affect the surgeon's ability to reconstruct defects in this area. The scalp has a rich vascular supply, the ability to withstand wounds of greater tension than other regions, and often has hair that can camouflage resulting scars or asymmetries. Nevertheless, most of the scalp is relatively inelastic and is ideally reconstructed with hair-bearing skin. These properties compromise the ease of effective reconstruction. However, multiple reconstructive options exist. The selection depends on the size and thickness of the defect, its location on the scalp, limiting comorbidities of the patient, and the need for immediate or delayed reconstruction. These options are reviewed in a systematic manner, organized by the factors outlined previously.

Humans↗

PubMed2004

Dermoscopic features of melanoma on the scalp.

There is a need to improve the early detection of melanoma of the scalp because it is characterized by a poorer prognosis compared with melanoma on other body sites. Dermoscopy is a useful tool for the early detection of melanoma but no previous reports on dermoscopic features of scalp melanoma have been published. We describe the first case of melanoma of the scalp seen by dermoscopy exhibiting a multicomponent global pattern with atypical pigment network, irregular streaks, and regression structures. In contrast to the dermoscopic features usually seen in melanoma occurring on the face, the same morphologic type of pigment network usually seen in melanoma of the trunk was observed in our case of scalp melanoma.

Dermoscopy↗

PubMed2005

Treatment of scalp angiosarcoma by controlled perfusion of A. carotis externa with pegylated liposomal doxorubicin and intralesional application of pegylated interferon alfa.

BACKGROUND: Angiosarcoma of the scalp is a rare but highly aggressive malignant tumor that differentiates toward vascular endothelial cells and shows a tendency for diffuse, often clinically occult spread. OBSERVATIONS: A 65-year-old Caucasian man presented with multiple erythematous skin lesions at the right scalp hemisphere and a prominent forehead edema that had developed during a period of 2 months. The clinical diagnosis of angiosarcoma was confirmed by histopathology. Because of the advanced local progression of the tumor and the unilateral localization on the right side of the scalp, we initiated an intra-arterial chemotherapy using pegylated liposomal doxorubicin (Caelyx) (8 mg/cycle every 4 weeks by an A. carotis externa port system). In addition, the patient received pegylated interferon alfa (50 microg/wk) by a percutaneous intralesional injection route. After 2 months, the tumor showed a marked regression; after 4 months, only one nodule located at the margins of the area perfused by the A. carotis externa persisted but regressed after focal irradiation. At 30 months after diagnosis, the patient shows no recurrence of tumor growth. CONCLUSIONS: In combination with intralesional interferon alfa, intra-arterial doxorubicin may be a promising innovative therapeutic option for localized scalp angiosarcoma, a hitherto poorly manageable and aggressive malignant tumor.

Aged↗

PubMed2005

A rare case of fatal primary cutaneous mucinous carcinoma of the scalp with multiple in-transit and pulmonary metastases.

BACKGROUND: Primary cutaneous mucinous carcinoma is a rare neoplasm derived from the sweat glands. It is usually located in the head and neck region, with the eyelids being the most common site of presentation. Recurrence following primary excision is common but metastasis is rare. CASE REPORT: We report a patient presenting with rapidly progressive cutaneous mucinous carcinoma on the right parietal scalp. Systemic work-up failed to reveal an occult primary source. The tumor was treated with Mohs micrographic surgery with clear margins. However, within two months, the patient developed new lesions on the scalp both adjacent to and separate from the original previously excised area, as well as metastasis to the right parotid gland. The patient received adjuvant radiation therapy both to the scalp lesions and to the parotid gland with apparent control of locoregional disease. However, two weeks after completing radiation therapy, the patient was found to have developed pulmonary metastases and died soon thereafter. CONCLUSION: Primary mucinous carcinoma arising in the skin is rare and usually follows an indolent course. We report the rare occurrence of a mucinous carcinoma of the scalp that developed multiple cutaneous tumors caused by in-transit metastases, as well as parotid gland metastases and eventual fatal pulmonary metastases.

Adenocarcinoma, Mucinous↗

PubMed2006

Videodermoscopy in the evaluation of hair and scalp disorders.

BACKGROUND: The standard methods used to diagnose scalp and hair disorders (eg, simple clinical inspection, pull test, biopsy) vary in sensitivity, reproducibility, and invasiveness. Studies on a few entities suggest that use of dermoscopy can improve clinical accuracy, but further investigation is needed. OBJECTIVES: We sought to: (1) characterize features of several nontumoral scalp and hair conditions using videodermoscopy; and (2) assess the potential usefulness of videodermoscopy in the clinical evaluation of these conditions. METHODS: Images (x20-70 magnification) obtained with videodermoscopy from 220 patients with various scalp and hair disorders and 15 unaffected control subjects were reviewed for distinguishing features. RESULTS: Conditions evaluated included psoriasis (23), seborrheic dermatitis (26), alopecia areata (58), androgenetic alopecia (64), chronic telogen effluvium (7), trichotillomania (12), and primary cicatricial alopecia (30). Clinical features evident to the naked eye were seen in great detail when videodermoscopy was used. Novel features (eg, yellow dots in alopecia areata) were also identified. LIMITATIONS: Findings require confirmation by blinded, prospective investigation. CONCLUSIONS: Use of videodermoscopy in the clinical evaluation of scalp and hair disorders improves diagnostic capability beyond simple clinical inspection and reveals novel features of disease, which may extend clinical and pathogenetic understanding.

Case-Control Studies↗

PubMed2005

Total scalp irradiation using helical tomotherapy.

Homogeneous irradiation of the scalp poses technical and dosimetric challenges due to the extensive, superficial, curved treatment volume. Conventional treatments on a linear accelerator use multiple matched electron fields or a combination of electron and photon fields. Problems with these techniques include dose heterogeneity in the target due to varying source-to-skin distance (SSD) and angle of beam incidence, significant dose to the brain, and the potential for overdose or underdose at match lines between the fields. Linac-based intensity-modulated radiation therapy (IMRT) plans have similar problems. This work presents treatment plans for total scalp irradiation on a helical tomotherapy machine. Helical tomotherapy is well-suited for scalp irradiation because it has the ability to deliver beamlets that are tangential to the scalp at all points. Helical tomotherapy also avoids problems associated with field matching and use of more than one modality. Tomotherapy treatment plans were generated and are compared to plans for treatment of the same patient on a linac. The resulting tomotherapy plans show more homogeneous target dose and improved critical structure dose when compared to state-of-the-art linac techniques. Target equivalent uniform dose (EUD) for the best tomotherapy plan was slightly higher than for the linac plan, while the volume of brain tissue receiving over 30 Gy was reduced by two thirds. Furthermore, the tomotherapy plan can be more reliably delivered than linac treatments, because the patient is aligned prior to each treatment based on megavoltage computed tomography (MVCT).

Brain↗

PubMed1994

Is the risk of perinatal transmission of human immunodeficiency virus increased by the intrapartum use of spiral electrodes or fetal scalp pH sampling?

OBJECTIVE: Our aim was to determine whether the intrapartum use of fetal scalp electrodes or fetal scalp pH sampling increases the rate of perinatal transmission of human immunodeficiency virus. STUDY DESIGN: The rate of perinatal transmission of human immunodeficiency virus in 31 monitored pregnancies was determined, and those pregnancies were compared with a control group of 117 pregnancies. RESULTS: The monitored group was comparable to the control group with respect to maternal age, race, human immunodeficiency virus risk behavior, CD4+ cell count, p24 antigen status, and stage of human immunodeficiency virus disease. The mean gestational age at delivery and the mean birth weight were similar in the monitored group and the control group. The perinatal transmission rate for the monitored group (29.0%) was not statistically different from that of the control group (25.6%). CONCLUSIONS: If confirmed by larger studies, our findings suggest that the intrapartum use of fetal scalp electrodes or fetal scalp pH sampling does not appear to increase the perinatal transmission of human immunodeficiency virus.

Adult↗

PubMed1997

Comparison of skin stapling devices and standard sutures for pediatric scalp lacerations: a randomized study of cost and time benefits.

OBJECTIVE: To compare the total costs and the physician time requirements for suture and staple repair of pediatric scalp lacerations. STUDY DESIGN: Eighty-eight children, 13 months to 16 years of age, coming to a children's hospital emergency department with simple scalp lacerations were prospectively randomly selected to receive staple or suture repair. Wound lengths, times required for initial wound care and closure, and equipment use were recorded. Patients returned in 1 week for suture or staple removal and wound reevaluation. The two methods were compared in terms of both time expended and costs of equipment and physician compensation. RESULTS: Forty-five children underwent staple repair and 43 underwent suture repair. There were no differences in age, sex, wound length, number of sutures or staples per centimeter, or physician experience. Stapling resulted in shorter wound closure times (65 vs 397 seconds; p < 0.0001) and shorter overall times for wound care and closure (395 vs 752 seconds; p < 0.0001). Staple repair was less expensive in terms of equipment ($12.55 vs $17.59; p < 0.0001) and total cost based on equipment and physician time ($23.55 vs $38.51; p < 0.0001). The follow-up rate was 91%, with no cosmetic or infectious complications in either group. CONCLUSIONS: Stapling is faster and less expensive than suturing in the repair of uncomplicated pediatric scalp lacerations, with no additional complications. Physicians who treat children with scalp lacerations should consider the use of stapling devices.

Adolescent↗

PubMed2001

Management of scalp defects.

This article presents a systematic approach to the reconstruction of scalp defects, which includes a review of the anatomy of the scalp as it pertains to reconstruction, and a discussion of the various reconstructive options for scalp defects, such as grafts and flaps. Further, scalp flap selection, design, and execution are outlined. Finally, adjunctive techniques of tissue expansion and hair transplants are included to enhance the final aesthetic result.

Humans↗

PubMed1979

Is the fetus "scalped" in labour?

Capillary blood-flow and tissue oxygenation of the scalp and/or forearm skin were measured in the three adult volunteers. Skin pressure required to occlude circulation was much lower for the scalp than for the forearm skin, and tissue oxygenation fell rapidly when capillary blood-flow fell below about 3 ml/100 g tissue/min. Since scalp circulation is not representative of the general circulation when pressure is applied, the tissue oxygenation level of the fetal scalp in labour (obtained by direct sampling or by transcutaneous electrodes) is not a good indicator of the well-being of a fetus.

Adult↗

PubMed2005

[Erosive pustulosis of the scalp: 3 cases].

BACKGROUND: Erosive pustulosis of the scalp is a rare entity of unknown etiology mainly affecting elderly people. It is often triggered by local trauma and features chronic pustules of the scalp evolving toward scarring alopecia. Its treatment is not yet codified. OBSERVATIONS: Two patients (66 and 87 years old) presented with crusted and erosive pustules of the scalp following surgical removal of actinic keratosis and total skin graft. In a third patient, similar lesions appeared after hair grafting. Clinical features were consistent with the clinical pattern of erosive pustulosis of the scalp. In all three patients, oral zinc gluconate in combination with topical steroids associated resulted in significant improvement. CONCLUSION: An association of topical steroids and oral zinc gluconate might be an interesting therapeutic option in this chronic, often disabling affection.

Administration, Topical↗

PubMed1996

Chronic telogen effluvium: increased scalp hair shedding in middle-aged women.

BACKGROUND: Diffuse loss of scalp hair is a common problem in middle-aged women. A segment of these cases represents idiopathic chronic telogen effluvium (CTE). OBJECTIVE: The purpose was to establish distinctive clinical and pathologic criteria for the diagnosis of CTE to facilitate its differentiation from androgenetic alopecia (AGA) and systemic causes of chronic diffuse hair loss. METHODS: A group of 355 patients (346 females, 9 males) with diffuse generalized thinning of scalp hair of unknown origin were classified as having CTE and were included in the study. Characteristically they presented with a history of hair loss with both increased shedding and thinning of abrupt onset and fluctuating course and showed diffuse thinning of hair all over the scalp, frequently accompanied by bitemporal recession. Two 4 mm punch biopsy specimens were taken mostly from the mid or posterior parietal scalp of these patients. The biopsies were performed at these same areas in 412 patients with AGA (193 male, 219 female). Similar paired biopsy specimens were also taken from 22 normal control subjects (13 males, nine females). Specimens were sectioned horizontally and vertically and were examined for terminal and velluslike (miniaturized) hairs, follicular stelae, follicular units, and perifollicular inflammation and fibrosis. RESULTS: In horizontal sections of 4 mm punch biopsy specimens from patients with CTE the average number of hairs was 39, the terminal/velluslike hair ratio was 9:1, 89% of the terminal hairs were in anagen, and 11% were in telogen. In AGA these values were 35, 1.9:1, 83.2%, and 16.8%, respectively, and in normal control subjects 40, 7:1, 93.5%, and 6.5%, respectively. Significant degrees of inflammation and fibrosis were present in only 10% to 12% of cases of CTE and normal controls, but occurred in 37% of cases of AGA. CTE ran a prolonged and fluctuating course in many patients. CONCLUSION: CTE, which usually affects 30- to 60-year-old women, starts abruptly with or without a recognizable initiating factor. It may be distinguished from classic acute telogen effluvium by its long fluctuating course and from AGA by its clinical and histologic findings.

Adolescent↗

PubMed2002

[Efficacy and tolerance of Algosteril (calcium alginate) versus Jelonet (paraffin gauze) in the treatment of scalp graft donor sites in children. Results of a randomized study].

Split skin graft is frequently needed in the treatment of burned patients. Scalp is often free of burns. Due to its good skin quality and important surface, scalp is a very interesting skin donor site, specially in case of children. A controlled, randomised clinical trial was carried out in 10 French Plastic Surgery or Burns Units. It assessed the efficacy and the acceptability of calcium alginate dressing (Algosteril) versus paraffin gauze dressing (Jelonet) in the treatment of scalp donor sites in children. 67 children (mean age 54 months) entered the study, 34 in the alginate group and 33 in the control group. Follow-up visits were on day 2/d3, d5/d6, Day complete healing, d30 and d60 after surgery. The two groups were comparable on inclusion (demographic characteristics, burn nature and surface, donor site surface and thickness of split skin graft). The mean healing time was 10 and 11 days for Algosteril and Jelonet group respectively (ns). The quality of the newly formed tissue was estimated to permit a sooner skin reharvesting in the Algosteril group than in the control group (p = 0.003). Bleeding through dressing was significantly less important in the Algosteril group (p = 0.02). Changes were considered by investigators less painful with Algosteril on day complete healing (p = 0.0096). Hair growth is homogenous in both groups on day 30 and day 60 (ns). These results showed that scalp is a very interesting skin donor site and that Algosteril is of a real interest in donor site treatment.

Alginates↗

PubMed2002

Use of skin staples to fix film dressings on scalp donor wounds in patients with burns.

Split-thickness skin grafts (STSGs) from the scalp have been used in large burns. The donor site wounds are usually covered using occlusive dressings, such as film dressings because they contribute to reduce donor site pain and infection under exudative crust and to enhance re-epithelialization. However, it is not always easy to fix such film dressings to the scalp because of the presence of hair. In this paper, we report the use of skin staplers to fix the film dressings. Eight donor sites in four patients were dressed in this way. The patients had 50-78% of the body burned, all of them survived. The mean healing time for the donor sites was 6.8 days. Three patients had their scalps re-harvested several times (range two to three times). There were no infections nor secondary skin ulcers at the donor sites. The technique of this dressing is very simple and speedy, thus we recommend the use of skin staplers to fix the film dressing to scalp donor wounds in patients with burns.

Adult↗

PubMed1999

A preliminary study of changes in scalp impedance during the early post-mortem period in rats.

An accurate and reproducible technique was used for estimation of scalp impedance (1 kHz) in each of eight rat cadavers, maintained at 9.0 +/- 0.7 degrees C, during the 1 to 144 hour post-mortem period. Scalp impedance increased non-linearly, and in a bimodal manner, between 24 and 144 hours post-mortem. The relationship between scalp impedance and post-mortem interval, and the degree of individual variation in the time course of impedance change, were such that scalp impedance is unlikely to be a suitable tool for estimation of time since death.

Animals↗

PubMed1998

P3 scalp topography to target and novel visual stimuli in children of alcoholics.

The P3 event-related potential (ERP) component was recorded from 7- to 18-year-old children of alcoholics (COAs, n = 50) and age- and sex-matched control children (n = 50) using a visual oddball paradigm, involving nontarget (76%), target (12%), and novel (12%) stimuli. Topographic maps of P3 and associated scalp current density were obtained to supplement a topographic profile analysis. COAs manifested a smaller amplitude P3 to target stimuli over the centroparietal, parietal, and occipital scalp locations than controls. Also, COAs exhibited a smaller amplitude P3 to novel stimuli over the occipital scalp than controls. There were no significant differences between COAs and controls in the P3 scalp topography, indicating that differences in intracranial source strength rather than in source configuration were responsible for the between-group amplitude differences. Also, no significant group differences were observed in the P3 peak latency or in behavioral performance. These results support the notion that the visual P3 may provide a vulnerability marker of alcoholism.

Adolescent↗