In August 1992, seventy-two-year-old man who had burned his scalp severely in his infancy presented with a progressive tumor of his vertex. The histology showed that the tumor was a squamous cell carcinoma. The outer growth size of the tumor was 47×37mm wide and 15mm high. The MRI revealed that the tumor had penetrated cranial bone and the lower end of the tumor had touched the dura. Additionally the vanguard of the tumor had already located besides the superior sagittal vein. We gave up the surgical removal because the superior sagittal vein at the rear of the coronal suture must be preserved.
We started continuous subcutaneous peplomycin injection (Pepleo® 5mg/day) for the initial therapy. When the total dose of peplomycin reached to 20mg, he showed symptoms of lung fibrosis (fever, crepitant rale and blood PO2 decline) . We had to abandon the peplomycin therapy. Four weeks prednisolone administration got recovery from the lung fibrosis.
Then we performed radiotherapy with combinations of local hyperthermia and oral etretinate administration. The electron irradiation schedule was 2 Gy a time with 5 times a week, and the total dose was 70 Gy. The local hyperthermia with microwave apparatus was done single time a week immediately after the electron irradiation. We combined the last two times' hyperthermia with 10mg cisplatin (Randa®) drip infusion respectively. The dose of oral etretinate was lmg per kg per day for a month. The combinations were through on November 13, 1992.
The combinations controlled the tumor nicely. He has come our clinic every two week for fifteen months after the combinations. Additionally we have checked MRI and skin biopsies every two or three months. There has been no evidence both of the metastasis and the recurrence.
Generally skin cancer arising from scars is contraindicated for radiotherapy because of the low blood flow and/or the hypoxia of the tissues decrease the sensitivity. In contrast to radiotherapy, hyperthermia is effective to the tumor under hypoxia. Our case has impressed that hyperthermia with combination of radiotherapy is effective to even skin cancer arising from scars.