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Liposarcoma of the head and neck is rare. Only 12 cases of scalp liposarcoma have been previously reported. In this report, we describe a case of myxoid/round cell liposarcoma in the scalp of a 28-year-old woman. This case report highlights a histologic pattern rarely reported in the head and neck but consistent with the evolving classification of liposarcomas.
Basal cell carcinomas (BCC) are the most common cutaneous malignant neoplasms affecting fair-skinned human beings. They may progressively enlarge and spread by peripheral extension. Intracranial invasion is very rare. A case of a giant BCC of the scalp invading directly into the left hemisphere through the frontal and parietal lobe and meninges is presented. Brain invasion along Virchow-Robin's spaces is demonstrated histopathologically. A review of literature failed to disclose a previous report of similar extensive and fatal cerebral invasion from a basal cell carcinoma of the scalp.
For Mohs surgical wounds that show exposed bone (ie, bone denuded of periosteum), healing by secondary intention may be preferable to surgical reconstruction. To determine the appropriateness of secondary intention healing, we reviewed surgical outcome in 205 patients with Mohs wounds of the scalp and forehead that had healed by secondary intention. Of these patients, 38 had Mohs wounds showing exposed bone. The mean area of exposed bone was 1074 mm(2); the mean area of exposed soft tissue was 1575 mm(2). The mean time for wounds with intact periosteum to epithelialize was 7 weeks; the mean time for bare bone to epithelialize was 13 weeks. All wounds healed without infection or tissue breakdown. We conclude that secondary intention healing of scalp and forehead wounds showing exposed bone is a safe and effective method of wound management after Mohs surgery.
A combination of split latissimus dorsi musculocutaneous flap with the serratus anterior musculo-osseous flap was used to cover a very large defect of the scalp. This technique offers a new alternative for single-stage reconstruction of extensive scalp defects.
Melanomas of the scalp are rare and have a poorer prognosis than melanomas arising at other cutaneous sites. In order to study the biology of this disease, the activity of the c-myc oncogene was studied in tumours from 25 patients with scalp melanoma using the technique of flow cytometry. Survival analysis revealed that stratification of patients according to oncogene activity provided a prognostic marker with shorter overall survival (log rank test, chi 2 = 3.9, P = 0.05) in tumours with high nuclear c-myc oncoprotein positivity. These results support our previous studies of the prognostic value of c-myc expression in melanoma and suggest that estimation of c-myc oncoprotein may be of clinical significance in identifying high risk patients.
Aplasia cutis congenita (ACC) is a rare malformation involving the scalp and sometimes the underlying tissues. It may occur as an isolated defect or be combined with congenital malformations and there is often a family background. The mortality rate is high, with infectious and vascular complications. We report our experience based on the treatment of 5 ACC of the scalp in children, where a family pathology was found.Controlled healing is the best approach for us, even for the serious forms. After the acute period, treatment is based on skin expansion and must be followed by genetic screening of the family.
A case of immediate replantation of an avulsed scalp by microvascular anastomosis is presented. Microvascular replantation of the scalp seems to offer significant social and psychological advantages over secondary reconstructive procedures. The significance of the case presented is the regaining of the motor neural function of the facial nerve after 38 months.
HISTORY AND FINDINGS: A 37-year-old woman was admitted with an ulcerated tumor of the scalp together with an enlarged cervical lymph node. The clinical features resembled proliferative trichilemmal cyst. INVESTIGATIONS: Fine needle aspiration of the lymph node revealed an amelanotic metastasis of a malignant melanoma. TREATMENT AND COURSE: The entire tumor was removed and a radical neck-dissection performed. Histopathological examination confirmed the diagnosis of metastatic malignant melanoma. CONCLUSION: Proliferative trichilemmal cysts and malignant melanoma of the scalp are rare, but should be considered as differential diagnoses of neoplasm in this part of the body.
Locally advanced cutaneous malignancy of the scalp is a disease that requires an aggressive approach to resection and reconstruction. In cases where the pericranium is intact a split-thickness skin graft is a simple treatment, since direct closure often fails because due to the lack of elasticity of the scalp. If there is a loss of periosteum or a skull defect local or free flaps are necessary for sufficient coverage. Increasing geriatric and polymorbid patients with impaired wound healing require surgical treatment, considering pros and cons for general anaesthesia. A simple method of both, combining radicality of tumor resection with outer table bone and skin grafting as a two stage procedure, while minimizing perioperative risk using local anaesthesia and analgo-sedation, using the vacuum assisted closure device, is presented.
Two premature infants with acute necrotizing fasciitis of the scalp are reported. In both cases the infection most likely arose from infiltrations of intravenous fluids into the subcutaneous region of the scalp. Aggressive surgical debridement, as well as antibiotic therapy, resulted in healing in both infants. A review of neonatal fasciitis is included.
My objective of this study was to find evidence of chaotic itinerancy in human brains by means of noninvasive recording of the electroencephalogram (EEG) from the scalp of normal subjects. My premise was that chaotic itinerancy occurs in sequences of cortical states marked by state transitions that appear as temporal discontinuities in neural activity patterns. I based my study on unprecedented advances in spatial and temporal resolution of the phase of oscillations in scalp EEG. The spatial resolution was enhanced by use of a high-density curvilinear array of 64 electrodes, 189 mm in length, with 3 mm spacing. The temporal resolution was advanced to the limit provided by the digitizing step, here 5 ms, by use of the Hilbert transform. The numerical derivative of the analytic phase revealed plateaus in phase that lasted on the order of 0.1 s and repeated at rates in the theta (3-7 Hz) or alpha (7-12 Hz) ranges. The plateaus were bracketed by sudden jumps in phase that usually took place within 1 to 2 digitizing steps. The jumps were commonly synchronized in each cerebral hemisphere over distances of up to 189 mm, irrespective of the orientation of the array. The jumps were usually not synchronized across the midline separating the hemisphere or across the sulcus between the frontal and parietal lobes. I believe that the widespread synchrony of the jumps in analytic phase manifest a metastable cortical state in accord with the theory of self-organized criticality. The jumps appear to be subcritical bifurcations. They reflect the aperiodic evolution of brain states through sequences of attractors that on access support the experience of remembering.
BACKGROUND: Treatment of white piedra remains an area of therapeutic frustration. Several topical and systemic antifungal agents have failed to eradicate the fungus and prevent disease recurrence. Itraconazole is a safe and effective systemic antifungal agent for various superficial and deep mycotic infections of the skin and hair. In vitro studies have shown significant antifungal activity against Trichosporon beigelii. OBJECTIVE: Our study was intended to assess the efficacy of itraconazole in the treatment of uncomplicated white piedra affecting the scalp hair. METHODS: The study was designed as an open trial involving 12 female patients with white piedra of the scalp hair. They were administered oral itraconazole 100 mg once daily until culture negativity was achieved; they were then followed up for 3 months. RESULTS: Eleven patients (91.67%) showed disease remission after 8 weeks of treatment. One patient (8.33%) showed no improvement, and the disease recurred in 2 patients (16.67%) after completion of therapy. No significant side effects were noted.
BACKGROUND: Preliminary studies indicate that topically applied immune response modifiers may be an effective and safe method of treating actinic keratoses (AKs). OBJECTIVE: Our aim was to study the potential efficacy of topical 5% imiquimod cream in the treatment of facial or scalp AKs and improve the safety profile by using a novel "cycle" dosing regimen. METHODS: This pilot study is an open-label trial that included 25 patients who had between 5 and 20 discrete AKs within a cosmetic unit of the forehead, scalp, or cheek. Treatment consisted of once-daily application of 5% imiquimod cream, 3 times a week for 4 weeks. to the entire cosmetic unit, followed by a rest period of 4 weeks. The cycle was repeated if any AKs remained after a complete 8-week cycle. A maximum of 3 cycles was permitted (24 weeks). Thirty-three sites in 25 patients were evaluated. RESULTS: Compliance was excellent with a very tolerable safety profile. Complete clearing of all AKs was noted in 82% (27/33) of anatomic sites in 25 study subjects. Almost half the sites (15/33) were clear at the end of the first cycle. A "therapeutic interval" was noted during the rest period wherein clinical inflammation subsided but AKs continued to clear. An added effect was the uncovering and clinical appearance and subsequent eradication of incipient (subclinical) AKs in the treatment area. CONCLUSION: There was excellent compliance with the cycle therapy regimen. The observations and hypotheses made in this pilot study will be tested in controlled, randomized trials with larger study populations. The identification of a therapeutic interval may prove to be beneficial in formulating individualized dosing regimens.
With this case study, we propose the use of the scalp as the donor site for vaginoplasty with split skin grafts. Patients with a congenital absence of a vagina should also benefit from the obvious advantages, which made the scalp the preferred donor site in burn patients.
A rare case of extraskeletal osteosarcoma of the scalp in a 56-year-old woman is described. At presentation she was found to have an 8-cm diameter, tender, firm, exophytic scalp tumor. MRI scan confirmed absence of underlying skeletal origin and showed extension along the subcutaneous plane. The tumor was excised and the patient received post-operative chemotherapy. Histologically, the tumor showed classical features of an osteogenic osteosarcoma with focal fibroblastic areas. In addition, there were rhabdoid cells present, which showed paranuclear cytoplasmic immunoreactivity for epithelial membrane antigen. The patient developed metastatic disease 6 months after surgical excision.
A 33 yr old man with a history of pilomatrixoma of the scalp, presented 5 mths later with a metastatic undifferentiated carcinoma in a submandibular lymph node. The cutaneous and lymph node tumors showed close histological similarity and features of malignancy. Investigations over 30 mths excluded a primary neoplasm elsewhere and consequently led to the diagnosis of malignant pilomatrixoma. These tumors are rare and most often located on the scalp. Most of the affected patients are middle age males. Wide excision is advised to avoid recurrences.
Large scalp defects that include periosteum set surgeons problems in closing the defect and in reconstruction of the hair-bearing area. The external tissue extension (ETE) technique together with a skin expansion device allowed us to reduce a 12 x 7.5 cm scalp defect and to construct a self-closing flap.
A newborn baby boy presented with a full thickness defect of the scalp, skull, and dura measuring 6 x 7 cm caused by aplasia cutis congenita. Full thickness loss is extremely rare and to our knowledge this case is the twenty-first reported. It has an established mortality of up to 55%. An encephalocele forced us to do an emergency operation with a single large scalp flap based on the supratrochlear and superficial temporal arteries. After revision the child is now 9 months old and progressing well. There are several ways to treat these rare and delicate cases.