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Is Three-Dimensional Virtual Planning in Cranial Reconstruction for Advanced Cutaneous Squamous Cell Carcinoma of the Skull a Feasible Option?

van de Vijfeijken, Sophie E.C.M. MD, PhD*,†; Slot, Mariam MD; Strackee, Simon MD, PhD§; Becking, Alfred G. MD, PhD*,†; de Lange, Jan MD, PhD*,†; Smeele, Ludi E. MD, PhD*,§,||; Schreuder, Willem H. MD, DDS*,§,||

doi: 10.1097/SCS.0000000000005895
Original Articles
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Background: Cutaneous squamous cell carcinoma (cSCC) is a common type of malignant skin disorder. An uncommon feature is local bony invasion, as can rarely be seen in lesions on the scalp. The optimal treatment strategy in these rare cases is still under debate.

Objective: The aim of this case report is to present a 1-stage three-dimensional planned surgical resection and reconstruction of a cSCC with bony invasion into the scalp and to discuss the alternative options and potential pitfalls.

Materials and methods: A patient diagnosed with rT4N0M0 cSCC of the scalp underwent a cranial resection and reconstruction in 1 stage. With the use of computer-assisted design and computer-assisted manufacturing a patient-specific implant (PSI) of poly (ether ether ketone) was manufactured. After the PSI was inserted, it was covered with a latissimus dorsi muscle and a split-thickness skin graft.

Results: Intraoperatively the resection template generated an accurate resection and accurate and fast placement of the PSI. The reconstruction had a clinical satisfactory esthetic result, but was hampered by the development of a small wound dehiscence was observed over the postoperative course.

Conclusion: Three-dimensional planned resection and reconstruction for composite defects of the skull after resection of a cSCC of the scalp with bony invasion may lead to an accurate and predictable resection and accurate and fast placement of the PSI. However, patient specific characteristics should be considered to assess potential risks and benefits before opting for this one-stage treatment strategy.

*Academic Centre for Dentistry, University of Amsterdam

Department of Oral and Maxillofacial Surgery

Department of Neurosurgery, Neurosurgical Center Amsterdam

§Department of Plastic and Reconstructive Surgery, Amsterdam University Medical Center

||Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam, the Netherlands.

Address correspondence and reprint requests to Sophie E.C.M. van de Vijfeijken, MD, PhD, Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; E-mail: s.e.vandevijfeijken@amc.uva.nl

Received 27 May, 2019

Accepted 11 July, 2019

This research is supported by the Dutch Technology Foundation STW (Project Nr. 14326; CranioSafe), which is part of the Netherlands Organization for Scientific Research (NWO), and which is partly funded by the Ministry of Economic Affairs.

CranioSafe Group: Collaborators include: A.G. Becking, L. Dubois, L.H.E. Karssemakers, D.M.J. Milstein and S.E.C.M van de Vijfeijken, Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, the Netherlands; P.R.A.M. Depauw, Department of Neurosurgery, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands; F.W.A. Hoefnagels and W.P. Vandertop, Neurosurgical Center Amsterdam, Academic Medical Center, University of Amsterdam, the Netherlands; C.J. Kleverlaan and T.J.A.G. Münker, Department of Dental Material Sciences, Academic Centre for Dentistry Amsterdam, the Netherlands; T.J.J. Maal, 3D Laboratory of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, the Netherlands; E. Nout, Department of Oral and Maxillofacial Surgery, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands; M. Riool and S.A.J. Zaat, Department of Medical Microbiology, Academic Medical Center, Amsterdam Infection and Immunity Institute, University of Amsterdam, the Netherlands.

The authors report no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.