Scalp Reconstruction after Excision of Radiation Induced Tumors

Abstract

Background: Exposure of scalp tissue to radiotherapy in childhood or the early adulthood period is at an increased risk of developing nonmelanoma skin malignancies. The anatomical and histological changes of scalp tissue make it difficult to close large defects after excision. Skin grafting usually fails, and complex flaps or vascularized tissue may be required. Objective: To explain the risk of skin tumors in all patients who received scalp irradiation therapy in childhood and the options of reconstruction after excision. Patients and Methods: Seven males and two females developed non-melanoma skin cancer on the scalp many years after radiotherapy for tinea capitis or for the management of brain tumors. Results: The large excision defect can be treated successfully by delayed reconstruction or by free flap. Conclusion: For any long-standing post-irradiation lesion, a new malignancy must be ruled out by biopsy. Complications are the rule, not the exception, whenever radiation defects are repaired surgically. Free flap is the best way of reconstruction, followed by the delayed reconstruction method.