Calvarium and Left Cerebral Parenchyma Involvement Arising from Squamous Cell Carcinoma in a Chronic Scalp Wound

Abstract

Squamous cell carcinomas (SCCs) of the scalp constitute a significant medical condition with relatively uncommon invasive growth and metastasis. 1 However, SCCs originating from Marjolin’s ulcer (MU) may have an altogether different course. Indeed, SCCs secondary to MU, by comparison with typical primary SCCs, not only have a considerable tendency to metastasize and invade to the calvarium and brain but also are associated with a significantly poor prognosis. 2 Typical primary SCCs of the scalp are mostly caused by cumulative ultraviolet exposure, followed by chronic wounds and scarring processes (mostly post-burn scars), with the latter referred to as “MU”. 3 Our case had a history of scalp burn, sustained in childhood, in the left parietal region of the head. Therefore, it should come as little surprise that his scalp SCC invaded into his calvarium and brain parenchyma. A 44-year-old man from Isfahan, Iran underwent surgery in our hospital due to the presence of a lesion (approximately 6×3.5 cm) on the scalp within an old burn injury. During the operation, the scalp lesion and the involved calvarium were resected. Intraoperatively, the frozen section procedure on the samples from the scalp and calvarium showed SCC involvement. Twelve months later, the patient returned because of the recurrence of the lesion. Rather than heal, the lesion had grown drastically and there were ulcerations and gangrenous discharge. On physical examination, he had aphasia, right-sided paresis, and serosanguinous drainage without signs of infection. Moreover, a lobulated, ulcerated lesion (approximately 20×8 cm) on the inflamed scalp surface with central ulceration was visible (