Scalp Reconstruction after Excision of Radiation Induced Tumors

Background: Exposure of scalp tissue to radiotherapy in childhood or early adulthood period are at increased risk of developing nonmelanoma skin malignancies. The anatomical and histological changes of scalp tissue make it difficult to close large defects after excision. Skin grafting usually fails, and complex flaps or vascularized tissue may be required. Objective: To explain the risk of skin tumor in all patient who received scalp irradiation therapy in childhood and the options of reconstruction after excision. Patients and Methods: Seven males and two females developed non melanoma skin cancer on the scalp at many years after radiotherapy for tinea capitis or for management of brain tumors. Results: The large excision defect can be treated succefully by delayed reconstruction or by free flap. Conclusion: For any long-standing post-irradiation lesion a new malignancy must be ruled out by biopsy. Complications are the rule, not the exception, whenever radiation defects are repaired surgically. Free flap is the best way of reconstruction followed by delayed reconstruction method.