Scalp metastases of glioblastoma multiforme: case report
Received: 13 July 2006 / Accepted: 22 July 2006 / Published online: 16 December 2006
Abstract Glioblastoma multiforme is an aggressive neo-
plasm of the central nervous system and skin metastases are
extremely rare. In this article, a patient who had rapidly
developing scalp masses after surgery for glioblastoma
multiforme is presented. The metastatic masses with
ulceration were disturbing for the patient and his family,
so he was operated on for palliative resection of the tumor.
The resulting extensive defect was reconstructed with a free
latissimus dorsi flap. Healing phase was uneventful and he
was discharged from the hospital on the ninth postoperative
day. A palliative surgery, even if it may necessitate a
complex reconstruction, can be recommended in specific
cases to improve quality of life and to ease patient care.
Keywords Glioblastoma multiforme
Glioblastoma multiforme (GBM) is a highly malignant
tumor constituting 15–23% of all intracranial malignancies.
It is most commonly seen in the fifth to sixth decade,
having a male predominance of 3/2 [4, 8]. The frontotem-
poral region is frequently involved. Aggressive resection of
the tumor and postoperative radiotherapy is the recom-
mended treatment modality . Extra neural metastasis,
most commonly to the lungs, lymph nodes, and bones, is
seen in less than 1% of all cases .
Skin metastases of GBM are extremely rare in the
literature [1, 3, 5]. A case of GBM with skin metastases is
reported, in whom a free flap reconstruction has been made
after palliative tumor resection.
A 58-year-old man diagnosed with GBM was operated on
for resection of the tumor in a neurosurgery clinic. The
patient was treated with 6,000 cGy of external beam
radiation therapy postoperatively. Thirteen months after
the intervention, induration of the scalp and fast developing
masses in the right frontoparietal skin were observed.
Cranial computed tomography (CT) and magnetic reso-
nance imaging examination revealed a scalp mass invading
the dura without any evidence of regional tumor recurrence
(Fig. 1). Upon physical examination, a painful, nodular,
and partially ulcerated mass of tumor tissue was detected in
the right frontoparietal region. The lesion was about
15Â20 cm at its greatest dimensions and had a foul-
smelling discharge. In addition to the main mass, several
small multiple satellite nodules were seen in the right
preauricular and occipital region. Bilaterally upper eyelids
were edematous and hyperemic (Fig. 2).
The prognosis and high mortality rate of metastatic
GBM was discussed with the family of the patient.
Although the operation would have no effect on survival,
they preferred surgery to improve the patient_s quality of
life. Therefore, the patient underwent resection of the
tumoral mass with the satellite nodules, including the
underlying parietal bone and dura (Fig. 3). The dural
defect of 8Â5 cm was reconstructed with tensor fascia lata
graft. To reconstruct the scalp defect of 20Â25 cm, the
same size of free latissimus dorsi muscle flap was harvested
Eur J Plast Surg (2007) 29:303–306
N. Ozturk (*)
Department of Plastic and Reconstructive Surgery,
Faculty of Medicine, Marmara University,