Introduction: Palpable skull lesions encompass a diverse group of histological entities. A review of these masses at one institution was undertaken for further insights.
Methods: An IRB approved retrospective review was undertaken to identify all patients who underwent surgical excision of a skull mass between 1997 & 2012.
Results: A total of 279 patients were identified, with no sex predilection (Male:140, Female:139). Non-malignant lesions totaled 264/279(95%) with dermoid cysts 142(52%) and Langerhan Cell Histiocytosis (LCH) 31(11%) being the most common. Malignant lesions accounted for 15/279(5%) and consisted of 4 primary malignancies and 11 metastatic lesions and included a diverse histology.
Pain to palpation was noted in 38/279 (14%), 35 of which were benign with LCH accounting for 17.
Mean age at diagnosis for malignant lesions was not significantly different from those non-malignant (59 and 69 months, respectively; p=0.1). No significant complication form the surgery was recorded in any patient.
At a mean follow-up interval of 17 months, recurrence was encountered in 8/15 malignant lesions and 5/264 benign masses, usually at the original site.
Only 42/279 (15%) had some form of preoperative imaging.
Conclusions: The overwhelming majority of skull masses can be completely and safely excised with preoperative imaging not needed for obvious lesions such as dermoid cysts.
Patient Care: This study aims to evaluate the safety and effectiveness of primary resection of skull lesions followed by histological evaluation in the treatment of pediatric skull lesions. The over reliance on imaging in altering the mode of treatment is discouraged in an effort to improve economization of healthcare resources.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Develop a rough idea of the histological distribution of head lumps 2) Discuss whether imaging is indicated for all asymptomatic, non-traumatic head 'lumps' 3) Draw inferences for when to expect recurrences.
References: 1. Cummings TJ, George TM, Fuchs HE, McLendon RE. The pathology of extracranial scalp and skull masses in young children. Clinical neuropathology 2004;23:34-43.
2. Martinez-Lage JF, Capel A, Costa TR, Perez-Espejo MA, Poza M. The child with a mass on its head: diagnostic and surgical strategies. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 1992;8:247-52.
3. Minor LB, Panje WR. Malignant neoplasms of the scalp. Etiology, resection, and reconstruction. Otolaryngologic clinics of North America 1993;26:279-93.
4. Ruge JR, Tomita T, Naidich TP, Hahn YS, McLone DG. Scalp and calvarial masses of infants and children. Neurosurgery 1988;22:1037-42.
5. Willatt JM, Quaghebeur G. Calvarial masses of infants and children. A radiological approach. Clinical radiology 2004;59:474-86.
6. Yiannias JA, Brodland DG. Transcranial eosinophilic granuloma manifested by a subcutaneous scalp mass. Differential diagnosis in children. The Journal of dermatologic surgery and oncology 1993;19:631-4.
7. Abe S, Yamamoto Y, Uno S, Andou M, Akasaka T, Mihm MC. Malignant melanoma arising in a sebaceous nevus of the scalp. British journal of plastic surgery 2003;56:171-3.
8. Rogers GF, Mulliken JB, Kozakewich HP. Heterotopic neural nodules of the scalp. Plastic and reconstructive surgery 2005;115:376-82.
9. Polis L, Brzezinski J, Dabrowska E, Waleszkowski J, Papiez W. [Cases of malignant neoplasms of soft tissues of the scalp]. Neurologia i neurochirurgia polska 1984;18:599-604.