Squamous Cell Carcinoma of the Scalp in Organ Transplant Recipients: Exploring Mechanisms for Recurrence and Treatment Guidelines

BACKGROUND The scalp is a target for squamous cell carcinoma (SCC) in male organ transplant recipients (OTRs) with alopecia. These tumors can behave aggressively and are associated with high recurrence, morbidity, and mortality. Treatment guidelines are needed for SCC in the scalp of OTRs. OBJECTIVE To explore the clinical and histologic features associated with SCC recurrence and aggressiveness in the scalp of OTRs. We review the mechanisms involved as they relate to a case. An algorithm for evaluation and treatment is introduced. METHODS An OTR presented with poorly differentiated SCC of the scalp that recurred on three occasions after Mohs micrographic surgery (MMS). The final recurrence invaded the bone and cranial cavity. We discuss the difficulties encountered in evaluating and treating these patients. RESULTS This patient had multiple factors associated with high tumor recurrence and aggressiveness. These were explored, and an algorithm was created. CONCLUSION SCC in the scalp of OTRs presents challenges for evaluation and management. We must be vigilant to monitor for recurrence, perineural invasion, bone invasion, multiple-field tumors, and metastasis. An understanding of the mechanisms of tumor recurrence will assist us in preventing morbidity and mortality in this subset of patients.