PDF(Pubmed)
Abstract：
Giant keratinocyte tumors, in particular basal cell carcinomas of the scalp area, are a serious challenge for dermatosurgeons, oncologists, and maxillofacial and reconstructive surgeons. The scalp area is limited in terms of skin mobility, and its elasticity decreases with age. The size of the tumors in this area and the degree of infiltration of the underlying tissues are important for the therapeutic choice, from surgical removal, waiting for granulations to form, and placing a split skin mesh graft (at a later stage) to performing complex rotational/transpositional or advancement flaps. Achieving an optimal aesthetic result is often the consequence of interventions carried out or based on the decisions of multidisciplinary teams. Alternatives, such as radiotherapy and targeted therapy with vismodegib, could be administered both preoperatively and postoperatively or as first-line therapy, depending on the tumor board decisions. We present the case of a 69-year-old female patient with a histopathologically proven preoperative giant basal cell carcinoma of the scalp that did not infiltrate the tabula externa. A preoperative ultrasound was performed to preserve the feeding flap arteries. Surgical treatment under general anesthesia was planned and subsequently carried out. During surgery, the surgical resection lines were in close proximity to the arterial vessels, but they remained preserved and ensured a subsequently unproblematic healing process. After the application of the rotational advancement flap technique under general anesthesia, an optimal cosmetic effect was achieved.
摘要：
巨大角质形成细胞肿瘤，特别是头皮区域的基底细胞癌，对皮肤科医生来说是一个严峻的挑战，肿瘤学家,以及颌面和重建外科医生。头皮面积在皮肤活动能力方面是有限的，它的弹性随着年龄的增长而下降。该区域肿瘤的大小和下层组织的浸润程度对治疗选择很重要，手术切除，等待颗粒形成，并放置分裂的皮肤网状移植物（在稍后阶段）以执行复杂的旋转/换位或推进皮瓣。实现最佳的美学结果通常是进行或基于多学科团队决策的干预措施的结果。Alternatives,如放疗和vismodegib靶向治疗，可以在术前和术后或作为一线治疗，取决于肿瘤委员会的决定。我们介绍了一名69岁的女性患者，其组织病理学证实为手术前头皮巨大基底细胞癌，但未渗入外膜。术前进行超声检查以保留供血皮瓣动脉。计划并随后在全身麻醉下进行手术治疗。手术期间,手术切除线靠近动脉血管，但是它们仍然保存下来，并确保了随后的治疗过程没有问题。全麻下应用旋转推进皮瓣技术后，达到了最佳的美容效果。
