[Basaliomas and their treatment]

Despite timely diagnosis of basiliomas, the results of their treatment depend on the size, localization of the process, and duration of the disease. According to some authors, in spite of the encouraging late results of surgery, cryotherapy, laser therapy, short-focus radiotherapy, etc., recurrences developed in 5% of cases, which is evidence that treatment lacks a radical character due to certain factors. Among the patients who were under our observation, two attracted particular attention due to ill-considered and, therefore, protracted treatment. We believe that radiotherapy, antineoplastic agents, electrocoagulation, and other methods should be mainly used when the basaliomas grow on the hfse fnd neck occurring on the trunk and extremities should be managed mostly by surgical excision.

Primary malignant melanoma of the lower lip

Melanomas in the anatomically complex area of the head and neck impose formidable obstacles to treatment. Mucosal melanomas, for reasons which remain uncertain, are associated with a poorer prognosis. Because no systemic treatment is known to be effective, increased awareness by patients and a high index of suspicion is warranted. The disease is potentially curable if diagnosed and treated at an early stage.

[Second primary tumors following treatment of squamous cell carcinoma of the oral cavity]

In the hospital of the Free University in Amsterdam (the Netherlands) 727 patients with primary squamous cell carcinoma of the oral cavity and lip have been studied for the incidence of second primary tumors occurring in the respiratory and upper digestive tract. Out of the 727 patients, 74 (10.2%) developed a second primary tumor in these tracts. The incidence of second primary tumors was expressed per 1.000 person-years of follow-up; 28 second primary tumors per 1.000 person-years of follow-up were seen in the respiratory and upper digestive tract. The patients ran the risk of developing a second primary tumor at a steady rate of approximately 2.8% per year during at least ten years. Furthermore, an increasing incidence of second primary tumors could be observed in case of increasing use of tobacco.

[Possible lung embolism following embolization of a hemangioma with fibrin glue]

More than 50% of all congenital haemangiomas are located on the head and neck. Because most orofacial haemangiomas exhibit the tendency to grow rapidly, they are often treated by embolisation and excision. CASE REPORT. The case of a 5-year-old patient is presented, who was admitted to the hospital for embolisation and immediate surgery of a haemangioma of the right side of the face and upper lip. After the injection of 2 ml fibrin glue she suddenly developed hypotension, tachycardia, a low oxygen saturation, and a low end-tidal carbon dioxide partial pressure. There was no failure of the breathing circuit and no airway obstruction could be found. Most likely these symptoms were due to transport of the fibrin glue from the haemangioma into pulmonary vessels. The therapy included the administration of heparin and antihypotensive drugs. After stabilisation, the patient was transferred to the intensive care unit for 1 day without further complications. CONCLUSION. Pulmonary embolism after injection of fibrin glue into an orofacial haemangioma has not previously been reported, but it should be considered that systemic complications can occur after injecting substances for embolisation into vessel-rich tissues.

Local interferon therapy for lip carcinoma

In a prospective non-randomized study 21 patients with lower lip squamous cell carcinoma were treated with human natural leukocyte interferon (HNLI). The response rate was measured by a size reduction of more than 25% and was 81%. A complete response rate was considered to be a cure according to histopathological and clinical findings and was 48%. The response rate of six lower lip squamous cell carcinoma cases treated with recombinant interferon alpha 2c was 67% and the complete response rate was 17%. Three patients with basal cell carcinoma of the upper lip were also treated with HNLI. All three patients were cured, as determined by histopathological and clinical findings. These findings indicate that interferon can be a useful alternative therapy for lip carcinoma either with or without surgery.

[A new method of treating lip cancer and a device for its implementation]

Immediate and late results of treatment of labial cancer in 132 patients are analyzed. The patients were exposed to radio-, thermoradio-, and thermochemoradiotherapy using a special electrode device which permits exerting a multifactorial physiopharmacological impact on the tumor. Complete resorption of the tumor occurs when total focal radiotherapeutic dose is reduced by 50%. Such a noticeable reduction of radiotherapeutic dose rules out quite a number of local and general complications.

Risk of multiple primary tumors following oral squamous-cell carcinoma

The follow-up of 727 patients with squamous-cell carcinoma (SCC) of the lip and oral cavity has been used for the risk analysis of multiple primary tumors (MPTs) following SCC of the lip and oral cavity. Age-, gender- and site-specific cancer-incidence rates from the general population have been applied to the appropriate persons-years of follow-up of patients with SCC of the lip and oral cavity. The study indicates that patients with a primary SCC of the lip and oral cavity have, compared with the general population, a significantly elevated risk of developing an additional cancer of the oral cavity and/or pharynx, the risk being 74.7-fold for males and 190.4-fold for females. Furthermore, a 24.6 and 45.3 times higher risk of an additional esophageal tumor was found in males and females respectively. The risk of cancer of the lung and pharynx was less elevated compared with the risk of cancer of the upper digestive tract. No elevated risks were established in organs outside the respiratory and upper digestive tract.

Tumoral infiltrate after local treatment with interferon in squamous cell carcinoma

Using monoclonal antibodies UCHL-1 (T lymphocytes), MT-1 (pan T) and L-26 (B lymphocytes) in the study of the tumoral infiltrate after local treatment with alpha interferon (Roferon) in patients with squamous cell carcinoma of the lower lip, it was observed that: the proportion of UCHL-1 positive cells was between 30% and 80%, the proportion of MT-1 positive cells was of 85% and that of the L-26 positive cells was of 30% of all the cells in the infiltrate. In the area in which after treatment with interferon the tumoral structures had disappeared, the proportion of T lymphocytes was smaller than in the areas in which the tumoral structures were still present. The therapeutic effect of interferon is due both to the direct effects on the tumoral cell and also to the indirect effects, namely the activation of the cytotoxic T lymphocytes and of other cells in the tumoral infiltrate.

Carcinoma of the lip

Carcinoma of the lip represents the most common malignancy of the oral cavity with an incidence in the United States of approximately 1.8/100,000. Lip cancers represent 15% to 20% of all malignancies of the oral cavity. With increasing public awareness of the harmful effects of solar radiation, physicians need to be aware of the etiological factors as well as appropriate treatment plans to ensure that patients obtain the most favorable outcome possible.

Therapeutic effect of intralesional interferon (Roferon) in squamous cell carcinoma

Recombinant alpha-2 interferon (IFN)--Roferon--100,000 IU/ml was intralesionally administered in 8 cases of squamous cell carcinoma (SCC) three times a week during 4-6 weeks in inoculations of 1 ml each. The therapeutic effect was scored as major--more than 60% reduction of the tumor size, moderate--30-60% reduction of the tumor mass and, nonreactive--less than 30% reduction of the tumor size. Three cases showed a major reduction, three showed a moderate reduction and two patients showed no reduction of the tumor volume. Histopathological examination of the surgically removed tumors after completion of the Roferon administration confirmed the clinical diagnosis of squamous cell carcinoma and revealed that an intense leukocyte, mainly lymphocytes, infiltration can be observed along with necrotic centers, progressively surrounding and reducing in size the tumor islets, thus proving an intense activation of the immune effector reactions against tumor cells.

Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip. Implications for treatment modality selection

We reviewed all studies since 1940 on the prognosis of squamous cell carcinoma (SCC) of the skin and lip. The following variables are correlated with local recurrence and metastatic rates: (1) treatment modality, (2) prior treatment, (3) location, (4) size, (5) depth, (6) histologic differentiation, (7) histologic evidence of perineural involvement, (8) precipitating factors other than ultraviolet light, and (9) host immunosuppression. Local recurrences occur less frequently when SCC is treated by Mohs micrographic surgery. This local recurrence rate differential in favor of Mohs micrographic surgery holds true for primary SCC of the skin and lip (3.1% vs 10.9%), for ear SCC (5.3% vs 18.7%), for locally recurrent (previously treated) SCC (10% vs 23.3%), for SCC with perineural involvement (0% vs 47%), for SCC of size greater than 2 cm (25.2% vs 41.7%), and for SCC that is poorly differentiated (32.6% vs 53.6%).

Neurotropic melanoma. A case report and review of the literature

Neurotropic melanoma is a rare tumor with a biphasic growth pattern associated with a change in morphology from melanocytic features toward Schwann cell features. The tumor thereby develops a capacity for infiltrating nerves which may result in clinically evident cranial neuropathies, most commonly of the fifth and seventh cranial nerves. The histology of this lesion is difficult to interpret; it often erroneously appears fibrous in origin and may be considered to be benign. Despite this benign appearance histologically, the tumor behaves aggressively with multiple local recurrences and possible CNS invasion by either direct perineural growth or distant metastases. We review the literature of neurotropic melanomas and report a 46th case which describes a typical course with neural invasion. Although a rare cause of cranial neuropathies, the neurologist should consider this entity in the differential diagnosis and the history of a recurrent skin lesion of the face should be sought whenever examining such a patient.

Impact of cervical lymph node metastases from squamous cell cancer of the lip

The records of 123 patients with squamous cell cancer of the lip presenting to the Vancouver Clinic of the British Columbia Cancer Agency from 1984 and 1988 were reviewed, and 4 were excluded from the study for various reasons. Initial treatment was surgery in 40, radiotherapy in 61, and combined in 18 patients. The primary tumor was staged as TIS in 11, T1 in 57, T2 in 24, T3 in 15, T4 in 1, and undetermined in 11. Follow-up continued for a minimum of 2 years in all but five patients. Lymph node metastases developed in 19 patients, representing 18% of the 108 patients with invasive cancer. The size of the primary tumor correlated with the likelihood of metastases. The neck disease was controlled in only 8 of the 19 patients with metastases, whereas control of the primary tumor was achieved in all but 3 patients. It is concluded that the development of node metastases in patients with lip cancer is more frequent than commonly appreciated and is associated with a high mortality rate. Close follow-up is essential to allow early detection of neck involvement. Aggressive surgery is indicated when such involvement becomes evident.

[Treatment of tumors of the oral cavity. Long-term follow up of 1223 cases. Clinico-experimental computerized processing using BMDP program]

The study assesses a series of 1223 patients treated for oral cavity neoplasm at the Institute of Oncology of Turin. It confirms the proportional deterioration of the survival rate in correlation with the advanced stage of the carcinoma. It shows the influence of the different types of treatment on survival, particularly referring to tumor site and stage at the time of first treatment.

[Treatment of lip angiomas]

The experience with the treatment of 25 patients with angiomas of the lips is presented. Among the several methods of treatment indicated in the literature, the authors have experimented with surgery, surgery and embolization, and systemic corticotherapy. Local application of corticosteroids and sclerosing agents were used just as a complementary therapy to the surgery. Surgery performed in one or more stages when necessary, were considered a safe and reliable method for treatment of mature venous angiomas, as well as for immature ones with no involution after a period of five years.

[The clinical picture and treatment of chronic lip fissures]

Fifty-seven patients with chronic recurrent labial fissures were administered multiple-modality conservative therapy including procaine blocking. The therapy was effective in 85 percent of patients: no recurrences were recorded over 5 years. The described method for therapy of chronic recurring labial fissures is recommended as a method of choice.

Squamous cell carcinoma of the lip

We reviewed 39 cases of squamous cell carcinoma of lip from 53 consecutive patients with carcinoma of the lip. The retrospective review includes age, location, risk factors, TNM classification, histologic differentiation, treatment methods, recurrent disease, site of recurrence, and follow-up status. Results reveal prognosis is related to original tumor size, local recurrence, and presence of cervical metastasis. Aggressive surgical treatment is recommended for identifiable poor prognostic lesions and includes surgical excision, prophylactic suprahyoid neck dissection, and possible radical neck dissection.

Current management of cancer of the lip

Carcinoma of the lip is the most common cancer of the oral cavity, occurring most frequently on the lower lip of elderly males. Less advanced neoplasms may be treated equally successfully by surgery or irradiation, and results are cosmetically acceptable by both methods. Reconstruction of the lip following surgical ablation of tumor usually consists of primary repair. Larger defects require flaps from the opposite lip, adjacent cheek, or more distant tissue. Although prophylactic neck dissection is usually not indicated, the presence of neck metastases from carcinoma of the lip is best managed by neck dissection followed by postoperative radiotherapy. The prognosis for curing lip cancer is dependent upon the size of the primary tumor and whether cervical metastasis has occurred. The overall five-year cure rate of lip cancer approximates 80%. The cure rate of patients with neck metastases is approximately 50%.

[The late treatment results in cancer of the lower lip]

Analysis of late results of treatment of carcinoma of the lower lip in 106 patients followed up for 4-5 years has confirmed that these results are worse if a patient consults a doctor late and if the process is disseminated. Our data evidence that late results do not depend on the method used to manage the primary focus on the lip, though radiotherapy may be considered as the optimal treatment modality. Histologic study of operation material after preventive surgery has not revealed metastases to regional lymph nodes, therefore if the lymph nodes are clinically intact, a dynamic follow-up is recommended after the primary focus is cured.

Therapeutic embolization of oral hemangiomas with absolute ethanol

Two patients, one with a high-flow arteriovenous hemangioma and the other with a low-flow capillary-venous type, were treated by injection of ethanol, and excellent results were obtained.

[The therapy of cervical adenopathies in tumors of the lip and oropharynx]

The authors, after some notes of topographic anatomy about the lymph nodes of the cervical area, examine the different therapeutic managements of lymph node metastasis of lip and oropharynx carcinoma. From these data, the authors put in evidence that almost all the surgeons and the radiotherapists do agree about the inclusion of radiotherapy, polychemotherapy and, more often, surgery in the treatment of cervical lymph node metastasis. The authors experience suggests no treatment of the cervical region in case of N0 lower lip cancer, especially if the neck is thin, and easy to examine, but it is necessary a careful follow-up in order to discover as soon as possible a clinic metastasis. They do not exclude that this behaviour could be suggested also in other neoplastic disorders, but the decision should be based on the histologic kind and grading, on the extension and on the possibility to exclude any cervical involvement. Beside this, the authors come to the conclusion that, in case of N1, N2, N3, the treatment of the cervical regions can not be avoided. The surgical treatment is the neck dissection, functional or radical, alone or together with radiotherapy and polychemotherapy. They finally report that the postoperative radiotherapy for cervical metastasis must be properly used when the capsular rupture is histologically proved.