(0693) Osteoradionecrosis of the Scalp

Introduction: Cutaneous carcinoma of the scalp is a common disease though vastly underreported and understudied in the literature. Many patients receive primary or postoperative radiation to the scalp, and complications from treatment are not well described. Osteoradionecrosis (ORN) of the scalp can be difficult to treat and it is imperative research be done to learn more about this disease. This is the first report to attempt to define the rates of ORN after scalp radiation and identify risk factors including surgery, radiation, and time to bone exposure.

Methods: This is a retrospective, single institution study of all patients undergoing scalp irradiation from 2018-2023. Information including diagnosis, surgery, amount of radiation, past medical history, time to bone exposure, and treatment were analyzed.

Results: In total, 57 patients received radiation to the scalp of which 47 of these patients had surgery followed by radiation. The average amount of radiation was 56.55 Gy. Of the total, 18 of the patients developed ORN of the scalp. The rate of ORN of the scalp was 31.58%. The average time of radiation to bone exposure was 941 days. Risk factors identified included history of scalp surgery, smoking, and obesity.

Conclusions: ORN is a common and underreported complication of scalp radiation with risk factors of prior surgery, smoking, and obesity identified in our study.