Maximal resection for malignant scalp tumors: is it valuable for long-term follow-up?

Background: Balancing surgical margins with effective scalp reconstruction remains a contentious issue in scalp tumor resection. This study aimed to define optimal surgical and therapeutic strategies for tumor resection and subsequent reconstruction in this complex anatomical region.

Methods: A retrospective study was conducted on 103 patients who underwent resection of malignant scalp tumors and reconstruction with flaps at Fudan University Shanghai Cancer Center. All patients received extended margin surgery followed by secondary treatment. Data collection included patient demographics, surgical details, defect characteristics, flap types, and treatment outcomes. The aesthetic outcome was assessed using a standardized five-point Likert scale, and follow-up data were collected through outpatient visits and telephone interviews until December 2023.

Results: Among the 103 patients, 4 experienced local recurrence, and 10 developed lymph node metastases. Additionally, six patients had postoperative complications. Regarding aesthetic outcomes, one patient was dissatisfied, six were neutral, and the remaining patients were satisfied. Three representative clinical cases are described in detail. This study represents the largest single-center surgical cohort for malignant scalp tumors with complete long-term follow-up reported to date.

Conclusions: This study proposes a novel concept: maximizing the tumor resection margin can effectively reduce local recurrence in patients, surpassing the traditional 2-cm margin. However, this approach does not significantly impact lymph node metastasis. Most patients undergoing scalp reconstruction with flaps achieved satisfactory aesthetic outcomes with minimal complications.