Background: Surgery for scalp malignancies is aimed at the complete resection and a good aesthetic outcome. The goal was to develop an algorithm for scalp reconstruction based on the authors' surgical experience.
Methods: This is a retrospective analysis of 123 procedures of scalp malignancies in 105 patients. Twenty eight procedures were for resection of squamous cell carcinoma, 54 for basal cell carcinoma, and 41 for suspected melanomas.
Results: Primary closure (27 procedures), local flap (LF; 19), split-thickness skin graft (SG; 64), rotated LF and SG (9), and free vascularized flaps (4) were used. Complications were partial (4) and total (1) necrosis of SG, free-flap atrophy (1), infection (2), wound dehiscence (1), and death due to cardiovascular complications (1). During follow-up, recurrence occurred in 22 patients (21%) and metastases to lymph nodes in 3 (3%).
Conclusion: Surface area size and the presence of the periosteum as well as a bone infiltration are important factors that can guide selection of a reconstruction method after resection of scalp malignancy.