Background: Organ transplant recipients are at a significantly higher risk of developing skin cancer compared to the general population, particularly cutaneous squamous cell carcinoma. Approximately 3–8% of these carcinomas are located on the scalp. Scalp reconstruction is particularly challenging, especially for large excisions, due to the thickness of the scalp, the inelastic aponeurosis of the galea, and the integrity of the hair-bearing scalp. Additionally, in organ transplant recipients, the presence of numerous comorbidities and the increased risk of infection due to immunosuppressive therapy make management more complex. Based on our experience and the existing literature, we aim to describe possible reconstruction methods and discuss the combined management of medical and immunosuppressive therapy. Method: We present our experience with seven kidney transplant patients who underwent excision of cutaneous squamous cell carcinoma with a diameter larger than 3 cm. The crane technique involves three key steps. First, the tumor is excised with wide margins of disease-free tissue. Next, a pericranial flap is rotated and positioned to cover the exposed cranial bone. Finally, a bilayer dermal substitute is applied to create a microenvironment that supports skin graft implantation. Results: The crane technique was used for six patients. In one case, an O-Z rotation flap was used. All patients modified their immunosuppressive therapy, with those receiving antiproliferative therapy switching everolimus after surgery. Conclusions: When combined with a post-operative modification of the immunosuppressive regimen, the crane technique could be considered a feasible, safe, and effective approach to managing large cSCC of the scalp in fragile patients.
背景：与普通人群相比，器官移植受者罹患皮肤癌的风险显著增高，尤其是皮肤鳞状细胞癌。其中约3–8%的癌变位于头皮。由于头皮组织较厚、帽状腱膜缺乏弹性以及生发头皮完整性的要求，头皮重建尤其具有挑战性，对于大面积切除更是如此。此外，器官移植受者常伴有多种合并症，且免疫抑制治疗会增加感染风险，使得治疗管理更为复杂。基于我们的经验和现有文献，我们旨在描述可行的重建方法，并探讨药物与免疫抑制治疗的联合管理策略。 方法：我们总结了七例接受直径大于3厘米的皮肤鳞状细胞癌切除的肾移植患者的治疗经验。起重机技术包含三个关键步骤：首先，在无病变组织的广泛边缘切除肿瘤；其次，旋转并定位颅骨膜瓣以覆盖暴露的颅骨；最后，应用双层真皮替代物创建支持皮肤移植物植入的微环境。 结果：六例患者采用起重机技术，一例采用O-Z旋转皮瓣。所有患者均调整了免疫抑制治疗方案，其中接受抗增殖治疗的患者在术后改用依维莫司。 结论：结合术后免疫抑制方案的调整，起重机技术可被视为处理脆弱患者头皮大面积皮肤鳞状细胞癌的一种可行、安全且有效的方法。
Management of Cutaneous Squamous Cell Carcinoma of the Scalp in Kidney Transplant Recipients
肿瘤(癌症)患者之家