Squamous Cell Carcinoma: Reconstruction of the Scalp

About Dr. Hootan Zandifar

Dr. Hootan Zandifar is board-certified in Otolaryngology and fellowship-trained in Facial Plastics and Reconstructive Surgery. Dr. Zandifar is the director of the Skin Center at the Osborne Head and Neck Institute based at Cedars-Sinai Medical Towers.

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About Dr. Ryan Osborne

Ryan F. Osborne, M.D. is the Director of Head and Neck Surgery at OHNI and is an internationally renowned expert in head and neck oncology. He has developed a special interest for the treatment of parotid gland tumors and focuses on the use of minimally-invasive techniques in the care of patients needing parotid surgery.

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I’ve had a large squamous cell cancer on my scalp. I would like it removed but I am also concerned about the defect. What should I do? 

Case Study 

The patient is a 74-year-old male who noticed a crusting lesion of his scalp. This grew rapidly. A biopsy of the lesion was consistent with squamous cell carcinoma. He underwent excision of the lesion with wide margins. The resulting defect was measured to be 3 cm by 3 cm. The patient underwent reconstruction by Dr. Zandifar. He did have a prolonged post-operative healing time due to the size and the location of the defect. The incision was treated post-operatively with silicone and laser. On follow up, the patient had only a slightly visible scar.


Figure 1: Lesion before excision

Figure 2: Lesion after excision but before reconstruction


Figure 3: 6 months after reconstruction


Skin cancers of the scalp are one of the hardest skin cancers to address. First, because most of the scalp is covered with hair the cancer is typically missed until it is larger in size. Second, the skin of the scalp is tight with little room to stretch and pull, making reconstruction a challenge.

It is not unlikely to need multiple procedures to fully reconstruct the scalp. In some cases, there may be a need for procedures such as tissue expander placements prior to reconstruction of the defect. This allows for stretching of the tissue around the defect and thus leads to extra skin being available for reconstruction. There is also increased need for post-operative care. Close wound care, use of topical treatments and lasers, and frequent follow-ups will usually lead to excellent cosmetic results. In almost all cases of scalp reconstruction, however, there is an increased post-operative healing time when compared to other locations on the face.

The physicians of the Osborne Head and Neck Institute are board certified in otolaryngology and plastic and reconstructive surgery. These surgeons carry a rare and complimentary subset of training specialties, allowing them to address not only the functional concerns of the nose but also the aesthetic implications of disease treatment.

To learn more about Dr. Hootan Zandifar or squamous cell carcinoma reconstruction, please visit: www.ohniskin.com.