Giant adenoid basal cell carcinoma of the scalp with intracranial involvement—successful management strategies for a rare entity

Adenoid basal cell carcinoma (BCC) is a rare but aggressive histologic subtype of BCC. The aim of this report is to present our multidisciplinary management strategy and a literature review on this seldom reported entity. A 72-year-old female with fungating giant BCC of the scalp, ear, and bone underwent preoperative biopsy revealing adenoid histology with infiltrating and nodular components. The patient underwent radical resection of the biparietal and occipital scalp, auriculectomy and craniectomy with dural resection. Immediate reconstruction of the intracranial and bony defect was performed with dural substitute and a titanium cranioplasty. The soft tissue defect was reconstructed with a latissimus dorsi free flap and split thickness skin graft using the right superficial temporal artery and vein as recipient vessels. Adjuvant external beam radiation was initiated postoperatively. Nearly 2 years postoperatively, she presented mesh exposure necessitating secondary reconstruction with debridement, hardware removal, and an anterolateral thigh (ALT) free flap, followed by flap debulking. Four years following initial presentation, she remains disease-free. To our knowledge, this is the only reported case of a giant, locally invasive scalp BCC with the adenoid subtype treated with composite resection and single stage reconstruction. Using an aggressive multimodal management paradigm, treatment and surveillance of the rarely reported, giant, locally invasive scalp BCC with adenoid subtype can result in a durable disease-free response and a functional, esthetic reconstruction. Evidence-based medicine level.

Level of Evidence: Level V, therapeutic study.