c l i n i c a l f o l i o s : d i s c u s s i o n

Squamous Cell Carcinoma



Related narratives: Squamous Cell Carcinoma of the Scalp,
Converse Flap for Squamous Cell Carcinoma, Mustarde Rotational Cheek Flap

Squamous cell carcinoma is the most common invasive malignancy of the head and neck (see neck masses) and the most common metastatic lesion involving the cervical lymph nodes. Lymph node matastasis reduces survival by 50% and is the most important prognostic parameter. From the regional neck node groups, the final common pathway is via the internal jugular and spinal accessory lymphatic chains.

Scalp lesions typically spread to level V nodes (posterior triangle). It remains a regional disease over long periods of time, and even when metastatic to cervical nodes, can be successfully treated with radical surgical resection (see radical neck dissection). Combination of radiation and surgery improves local and regional control but has not been shown to improve survival.

Coverage of the wide scalp defect required a composite musculocutaneous free graft. The substantial nature of the flap allows the use of adjuvant radiotherapy without risking necrosis of a thinner split thickness graft. Free flaps using microvascular technique (see principles of microsurgery) have largely supplanted rotational pectoralis flaps for head and neck reconstruction.


Sabiston: Textbook of Surgery, 15th ed., Copyright 1997 W. B. Saunders Company: 1320-1322.

This page was last modified on 12-Dec-2000.