Page 141 - Clinical relevance of current materials for cranial implants

Virtual surgical planning for skincancer with cranial bone invasion
INTRODUCTION
Actinic keratosis is a high prevalence premalignant skin disorder. Commonly, the affected area shows multiple undefined erythematous scaling papules or plaques of 1-3 mm. Due to the variable and nonspecific c linical presentation, diagnosis and treatment are frequently delayed. Untreated actinic keratosis may develop into malignant cutaneous squamous cell carcinoma (cSCC). 1
CSCC is a common type of skin cancer with a high prevalence, especially in elderly and in immunosuppressed patients2–4. CSCC presents mostly on sun exposed surfaces of the skin such as the underarm, face and scalp. The preferred location is the external ear and lower lip3,5. CSCC initially starts with an asymptomatic painless, rough patch of the skin which may progress into an ulcerated tumor with radial spread at diagnosis6,7.
For cSCC in general, but also for lesions located on the scalp, local bony invasion remains
an uncommon feature. When the cranium is affected, there is no consensus about the
optimal treatment strategy (radiotherapy vs surgery)8. In case of surgery, reconstruction
of these composite defects by cranioplasty in addition to soft tissue reconstruction may 7 be recommended because of better protection of the brain, increase of psychosocial
aspects and improvement of esthetic outcome9–13. Time interval between diagnosis and surgery in case of craniectomy for cSCC, allows for preoperative digital surgical planning. This gives the surgeon the opportunity for 3D planned cranial resection and symmetric reconstruction of the cranial vault in one stage. Besides the most important advantage of saving the patient additional surgical procedures, it may also help to achieve more accurate and predictable resection margins.
The aim of this case presentation is to demonstrate a one stage 3D planned surgical resection and reconstruction of a recurrent cutaneous squamous cell carcinoma of the scalp with bone invasion, followed by discussion of alternative options and potential pitfalls.
139