Malignant cancers arising in the scalp may exhibit calvarial invasion, dural extension, and rarely cerebral involvement. Typically, such lesions require a multidisciplinary approach involving both neurosurgery and plastic surgery for optimal resection and reconstruction. The authors present a retrospective analysis of patients with scalp malignancies who underwent resection and reconstruction.

Patients presenting with scalp malignancies (1993–2021, n = 84) who required neurosurgical assistance for tumor resection were prospectively entered into a database. These data were retrospectively reviewed for this case series. The extent of neurosurgical resection was classified into four levels of involvement: scalp (level I), calvarial (level II), dural (level III), or intraparenchymal (level IV). Complications and evidence of local, locoregional, or regional recurrence were documented.

Patients underwent level I (n = 2), level II (n = 61), level III (n = 13), and level IV (n = 8) resections. Pathologies consisted of primarily squamous cell carcinoma (n = 50, 59.5%), basal cell carcinoma (n = 11, 13.1%), and melanoma (n = 9, 10.7%), with infrequent lesions including sarcoma, atypical fibroxanthoma, and malignant fibrous histiocytoma. For cases requiring a cranioplasty, 92.2% were done using titanium mesh and 7.8% with methylmethacrylate. At a mean follow-up of 35.5 ± 45.9 months, the overall survival was 48.8% (n = 41) and recurrence-free survival was 31.0% (n = 43). Scalp-based reconstruction involving plastic surgery was performed in 75 (89.3%) patients. The most commonly used free flap was a latissimus dorsi muscle flap (n = 46, 61.3%). One or more postoperative complications occurred in 21.4% of all patients, the most common being wound dehiscence or delayed wound healing in 13% (n = 11).

A multidisciplinary approach with aggressive neurosurgical resection is associated with good outcomes in patients with primary malignant scalp tumors, despite invasive disease on presentation. This analysis suggests that aggressive resection (level II and higher) is effective at reducing locoregional recurrence and is not associated with a higher risk of complications relative to resection without craniectomy. As most patients require scalp reconstruction to close the postresection defect, usually with vascularized free tissue transfer, involving a plastic surgeon in the surgical planning and execution is essential.

头皮中发生的恶性肿瘤可能会侵犯颅骨、硬脑膜延伸，很少会累及脑部。通常，此类病变需要采用涉及神经外科和整形外科的多学科方法，以实现最佳切除和重建。作者对接受切除和重建的头皮恶性肿瘤患者进行了回顾性分析。

需要神经外科协助进行肿瘤切除的头皮恶性肿瘤患者（1993-2021 年，n = 84）被前瞻性地输入数据库。本病例系列对这些数据进行了回顾性审查。神经外科切除范围分为四个受累级别：头皮（I 级）、颅骨（II 级）、硬脑膜（III 级）或实质内（IV 级）。记录了并发症和局部、局部区域或区域复发的证据。

患者接受了 I 级 (n = 2)、II 级 (n = 61)、III 级 (n = 13) 和 IV 级 (n = 8) 切除。病理学主要包括鳞状细胞癌 (n = 50, 59.5%)、基底细胞癌 (n = 11, 13.1%) 和黑色素瘤 (n = 9, 10.7%)，罕见病变包括肉瘤、非典型纤维黄瘤和恶性纤维组织细胞瘤。对于需要颅骨成形术的病例，92.2% 使用钛网完成，7.8% 使用甲基丙烯酸甲酯完成。平均随访时间为 35.5 ± 45.9 个月，总生存率为 48.8% (n = 41)，无复发生存率为 31.0% (n = 43)。 75 名 (89.3%) 患者进行了涉及整形手术的头皮重建。最常用的游离皮瓣是背阔肌皮瓣（n = 46，61.3%）。 21.4% 的患者出现一种或多种术后并发症，最常见的是伤口裂开或伤口愈合延迟，占 13% (n = 11)。

尽管表现为侵袭性疾病，但采用积极的神经外科切除术的多学科方法与原发性恶性头皮肿瘤患者的良好预后相关。该分析表明，积极切除（II级及更高级别）可有效减少局部复发，并且与不进行去骨瓣切除术的切除相比，与较高的并发症风险无关。由于大多数患者需要进行头皮重建来闭合切除后的缺损，通常采用血管化游离组织移植，因此整形外科医生参与手术计划和执行至关重要。