CARCINOMA ESCAMOCELULAR DE CUERO CABELLUDO DE COMPORTAMIENTO INFILTRATIVO: DIAGNÓSTICO Y MANEJO
Palabras clave:
carcinoma escamocelular cutáneo; cuero cabelludo; invasión; calota; cirugía de Mohs; radioterapia; inmunoterapia; PRISMA 2020Resumen
DOI: https://doi.org/10.46296/yc.v10i19.0980
Resumen
Introducción: El carcinoma escamocelular cutáneo (CEC) del cuero cabelludo constituye una localización de especial complejidad por su exposición solar acumulada, la limitada distensibilidad tisular y la proximidad inmediata de galea, periostio, calota y duramadre. Los tumores infiltrativos pueden presentar extensión subclínica, invasión perineural, afectación ósea y metástasis regional. Objetivo: sintetizar la evidencia sobre diagnóstico, estadificación y manejo del CEC infiltrativo del cuero cabelludo. Métodos: revisión sistemática siguiendo PRISMA 2020. Se realizó una búsqueda principal en PubMed desde enero de 2010 hasta el 4 de septiembre de 2026, complementada con búsqueda de referencias en OpenAlex y Google Scholar. Se incluyeron estudios clínicos, cohortes, series y reportes con información específica sobre CEC del cuero cabelludo y desenlaces diagnósticos, quirúrgicos, radioterápicos o sistémicos. Resultados: la búsqueda principal identificó 95 registros; 44 textos completos fueron evaluados y 28 estudios integraron la síntesis cualitativa. Los factores de mayor riesgo fueron invasión profunda, compromiso de galea/periostio, mala diferenciación, invasión perineural, inmunosupresión, recurrencia y enfermedad ganglionar. La cirugía con control histológico de márgenes continúa siendo la estrategia preferida en enfermedad resecable. La resonancia magnética es especialmente útil ante sospecha de invasión perineural o intracraneal, mientras que la tomografía computarizada permite valorar erosión cortical. La radioterapia es una alternativa o complemento en enfermedad localmente avanzada, márgenes comprometidos no resecables e invasión perineural; los inhibidores de PD-1 son esenciales en enfermedad irresecable o metastásica. Conclusiones: el CEC infiltrativo del cuero cabelludo debe abordarse como una entidad de alto riesgo. La evaluación de profundidad y estructuras profundas, el control completo de márgenes y la planificación multidisciplinaria son determinantes para reducir recurrencia y progresión.
Palabras claves: carcinoma escamocelular cutáneo; cuero cabelludo; invasión; calota; cirugía de Mohs; radioterapia; inmunoterapia; PRISMA 2020.
Abstract
Introduction: Cutaneous squamous cell carcinoma (cSCC) of the scalp presents a particularly complex clinical scenario due to cumulative sun exposure, limited tissue extensibility, and the immediate proximity of the galea, periosteum, calvarium, and dura mater. Infiltrative tumors may exhibit subclinical extension, perineural invasion, bone involvement, and regional metastasis. Objective: To synthesize the evidence regarding the diagnosis, staging, and management of infiltrative scalp cSCC. Methods: A systematic review was conducted following PRISMA 2020 guidelines. A primary search was performed in PubMed covering the period from January 2010 to September 4, 2026, supplemented by reference searches in OpenAlex and Google Scholar. Included studies comprised clinical trials, cohort studies, case series, and case reports containing specific data on scalp cSCC and diagnostic, surgical, radiotherapy, or systemic outcomes. Results: The primary search identified 95 records; 44 full-text articles were evaluated, and 28 studies were included in the qualitative synthesis. Key risk factors identified were deep invasion, involvement of the galea or periosteum, poor differentiation, perineural invasion, immunosuppression, recurrence, and nodal disease. Surgery with histological margin control remains the preferred strategy for resectable disease. Magnetic resonance imaging (MRI) is particularly useful when perineural or intracranial invasion is suspected, whereas computed tomography (CT) allows for the assessment of cortical erosion. Radiotherapy serves as an alternative or adjunct treatment for locally advanced disease, unresectable involved margins, and perineural invasion; PD-1 inhibitors are essential for unresectable or metastatic disease. Conclusions: Infiltrative scalp cSCC should be managed as a high-risk entity. Assessment of tumor depth and deep structures, complete margin control, and multidisciplinary planning are crucial for reducing recurrence and disease progression.
Keywords: cutaneous squamous cell carcinoma; scalp; invasion; calvaria; Mohs surgery; radiotherapy; immunotherapy; PRISMA 2020.
Información del manuscrito:
Fecha de recepción: 14 de abril de 2026.
Fecha de aceptación: 22 de junio de 2026.
Fecha de publicación: 10 de julio de 2026.
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