Impasse in the management of recurrent basal cell carcinoma of the skull with sagittal sinus erosion

• A rare case of an enormous basal cell carcinoma of the scalp
• Invasion and erosion the superior sagittal sinus provoking sudden massive bleeding
• Early surgical treatment of BCC before involvement of major intracranial vascular structures
• Radiotherapy management may reduce the healing process of the skin
• Non-surgical treatment of the SSS hemorrhage

Basal cell carcinoma (BCC) is a non melanocytic skin cancer that arises from basal cells, affecting commonly fair-skinned human beings. Although the tumor is well known for local recurrences, extension into the intracranial space is reported. A case of a giant BCC of the scalp invading the middle and posterior third of the superior sagittal sinus (SSS) is reported. A 70-year-old male with a basal cell carcinoma history presented with a massive bleeding from the SSS invaded by the tumor. Since the patient refused surgery the bleeding was managed through direct compression by applying a thrombin-based hemostatic agents and sterile dressings. This procedure was performed daily in order to stimulate the spontaneous thrombosis of the dural sinus and development of collateral circle. BCC invading the SSS is rarely reported. A technical description of this case is provided. This case underscores the importance of early and appropriate treatment for high risk BCC, and whenever surgical procedure is not suitable appropriate conservative treatment may be efficacious.