External bump on head after craniontomy and radiation - 1261811

larrylm53
Posts:4

I had a craniotomy on Nov. 5-2013. and a 1.6 cm. tumor was removed from my left parietal lobe and found to be squamous cell carcinoma. I had a CT scan 5 weeks post surgery and all was good. My rad. onc did 10 days of tomotherapy rad to the tumor bed, it was completed Jan. 2-2014. About half way through the rad tx 2 bumps began to form either side of the incision. They protrude about 1/4 inch and about 3/4 inch in diameter. My neuro surgeon glanced at it and said it was muscle that wasn't layed down properly and it would heal in time. My rad onc said he had never seen anything like this before and to give it a little time. I have a 5"diameter bald spot from the rad tx and the bumps are at the lower end of the incision where no hair was lost. The bumps don't seem to be growing but the whole back of my head is hurting about a 7 on the 1 thru 10 pain scale. The bumps themselves are really sore to touch. I called my rad onc and he is going to call my neuro surgeon and see what can be done. If you have any opinion at all that I can share with him I would appreciate it. I keep hoping it will just go away but it seems to be getting worse. Thank you.

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Reply # - January 28, 2014, 01:34 PM

JimC
Posts: 2753

In response to a similar question about painful bumps on the head after a craniotomy, Dr. West said:

" If they aren’t where the screws for a “halo” for the radiation were placed, I don’t think the radiation oncologist would be the leading choice. For things that are right along where the scar is, I’d say the surgeon is a good first choice, if that person is reachable. It sounds most like an infection could be the cause — you really wouldn’t expect to see new metastases right at the skin in this situation.

The oncologist also might be able to offer some insight." - http://cancergrace.org/topic/question-about-after-brain-surgery-cyberkn…

I hope you can get some answers from your surgeon or oncologist, and that the problem clears up soon.

JimC
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Reply # - January 28, 2014, 02:04 PM

larrylm53
Posts: 4

Thanks for the quick response. I have NSCLC squamous cell carcinoma and the tumor is thought to have spread to the brain. When I was having the rad there was a mask formed to my face and at each treatment my head was secured. There was a ridge in the dish that I laid my head on and by the last day the pain was almost more than I could stand for 6 Minutes. The ridge was right at the incision and I wonder if it could have separated the muscle or reshaped my skull? It has been 6 weeks and I know healing takes time but it seems to be getting worse. My rad onc is Dr. Sanford Katz--- Willis Knighton and I really do have faith in him. Thanks

Reply # - January 28, 2014, 04:24 PM

Dr West
Posts: 4735

There's nothing you'd really expect here, and I suspect it's something that isn't cancer and isn't infection, some kind of inflammation there or maybe some fluid that isn't draining well...If these were firm and growing, my first suspicion would be that these are deposits of cancer, but I also suspect that the neurosurgeon and/or radiation oncologist would recognize that possibility if that was likely after looking at them.

So I can't say I know what this is any better than the docs who are looking at them directly, but it sounds most likely to be nothing serious and just some kind of reaction/inflammation related to the incision, and there's likely not anything to do for that. If these worsen, further workup, including a biopsy or trying to drain them, would be the next step.

Good luck.

-Dr. West

Reply # - March 4, 2014, 05:32 AM

larrylm53
Posts: 4

This is Larry Moore and I am updating my earlier post. The bumps on my head continued to get more painful but I was unable to get my neuro surgeon to be concerned. Finally on Feb 25th I went to the ER. They scheduled me to see a general surgeon on the Feb. 26. He took one look and said those have to come off and he scheduled me for surgery. He said that head surgery was not his area of expertise and that he would contact the neuro surgeon and get his input.---------I no sooner got home then the phone rang and I was told not to eat anything after midnight and I would be having surgery to remove the bumps the next morning by the surgeon who did my craniotomy on Nov. 5--2013. All I have been told is the bumps were squamous cell carcinoma and extra was taken out around them. I have been told that I should be hoping the pathology report shows clear margins. If not I could be looking at more radiation ? I don't know why it took 2 months to get something done ? The pain had become unbearable.-------The bumps were on the outside of my skull near the incision. Do you think they were spread there during surgery or can they even grow that fast ? Do you think they could have grown into the bone ? There turned out to be 3 and they were about the size of the tip of my thumb. I am having the staples removed tomorrow ( March 5th 2014 ) and I hope to get more information. Thanks for listening.

Larry
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Reply # - March 4, 2014, 06:27 AM

Dr West
Posts: 4735

I suppose it's possible that there was seeding of the cancer into the incision -- that would be a leading suspicion when the lesions come up in or around the incision just after surgery. That said, it's also possible that they just popped up independently from the same metastatic process that led the cancer to go to the brain.

Either way, the fact that the cancer had already gone to the brain means that the real issue is metastatic disease that needs to be managed primarily with systemic therapy. In that sense, the presence of a few additional skull lesions doesn't substantially change the overall picture. Still, I'm sorry you're having to deal with this complication -- though I'm glad you're getting some answers at long last.

-Dr. West

Reply # - March 4, 2014, 06:41 AM

larrylm53
Posts: 4

Dr. West, I had a Ct scan 5 weeks after my craniotomy and it was clear. I received 10 days of radiation ending on Jan 2--2014. Then I had an MRI on Feb. 5th 2014 and nothing showed up. Other than the physical bumps and the pain there were no signs. I don't blame my doctors but I am glad things are happening. Thank you very much for your quick response.

Larry

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