[Embolization therapy of cavernous hemangiomas]

Hemangiomas are the most frequent tumors found in newborns, but mostly regress by the age of 7. Spontaneous progression and such complications as hemorrhage, disseminated intravascular coagulation (Kasabach-Merritt syndrome), threatened cardiovascular decompensation, and threatened interference with vital functions are rare and must be treated. Embolization therapy is a new therapeutic approach: vascular malformations and hemangiomas with pronounced arteriovenous shunts are treated by selective arterial embolization of the most peripheral branches of the supplying blood vessels. In contrast, lesions with a steady, slow blood perfusion can be treated by direct embolization of the cavernous system; further thrombosis and organization of the thrombus may lead to a permanent and complete occlusion of the hemangioma. If permanent occlusion cannot be achieved, temporary or partial thrombosis may allow curative plastic or reconstructive surgery, which would otherwise be impossible.

Some oncologic considerations in the treatment of lip cancer

We evaluated the treatment and results of 46 patients with lip cancer of commissure origin or extension. The patients were evaluated by clinical stage and pathologic findings. Treatment was predominantly by surgery for T1 and T2 lesions (31 of 37 patients), whereas combined resection and radiation therapy was used for larger tumors. The results showed control of both very large and very small lesions, but T2 lesions had repeated recurrences. We therefore recommended aggressive therapy for T2 and higher classifications of lip cancer with commissure involvement.

Merkel tumor of the lower lip: a case report and updated review of the literature work performed at the University of Illinois

An unusual case of Merkel cell carcinoma of the lower lip with metastasis to the submental nodes is presented. Clinical similarities and the histopathologic and prognostic differences between this tumor and basal or squamous cell carcinomas of the head and neck area are discussed and the current thoughts for treatment are presented. The capricious clinical course and the aggressive nature of the Merkel cell tumor is emphasized. A review of the existing literature is also included in an effort to familiarize the head and neck surgeon with this relatively new but potentially lethal pathological cutaneous entity.

Squamous cell carcinoma of the skin in black patients with discoid lupus erythematosus

Skin cancer is relatively uncommon among black individuals. Squamous cell carcinoma occurred in a scar of chronic discoid lupus erythematosus in a black patient. A review of 7 previously reported cases of squamous cell carcinoma in blacks with chronic discoid lupus erythematosus indicates a tendency of the cancer to metastasize. Sun exposure of the hypopigmented lesions of chronic discoid lupus and possibly other factors predispose to cancer of the skin. Poorly healing skin lesions in chronic discoid lupus should arouse suspicion of malignant change.

Carcinoma of the oral cavity and oropharynx

A high index of suspicion in smokers, coupled with inspection and palpation, is necessary for early diagnosis of cancer of the oral cavity and the oropharynx. Surgery or radiotherapy, or a combination of those modalities, is usually successful, except in advanced cases of cancer of the tongue base and the oropharynx.

[New aspects in the treatment of hemangioma]

This paper describes the successful therapy of cavernous and capillary haemangiomata by inducing thrombosis with Tissucol homologous fibrinogen and thrombin. After angiography, infants and small children were injected with Tissucol directly into the vascular convolution at two weekly intervals, resulting in complete thrombosis with subsequent fibrosis, leading to diminution of the haemangioma until it finally disappeared. Histological examination showed fibrosis and sclerosis, with granular tissue rich in fibrinoblasts as a manifestation of a partially organised thrombosis. There were no traces of inflammation. In a large number of adults, reduction of the haemangioma was successfully achieved by injections of Tissucol, leading to thrombosis, followed by immediate surgical removal of the entire haemangioma. Treatment of small haemangiomata by cryosurgical measures with liquid nitrogen, as recommended by Lexer in 1921, was likewise successfully applied.

[Choice of the treatment for lip carcinoma--an analysis on 74 cases]

This paper reports the results of the treatment of 74 patients with lip carcinoma from 1958-1974. All patients were proved by pathology and received their first course of treatment in our hospital. 44 of these patients were treated by radiation and 30, by surgery. The over-all five-year survival rate is 59% (44/74). Satisfactory results were obtained in the early lesions (stages I, II) either by surgery or radiation and the five-year survival rates are 66% (surgery 6/9, radiation 4/6). For stages III and IV, the result of operation is better than radiation's. The five-year survival rate in the former is 71% (15/21) and in the latter is 50% (19/38). In the stage IV lesions (T4), surgery was contraindicated but radiation was still able to cure 25% (1/4) of the patients. The optimal dose for the primary lesion was 6000-8000 rad/6-8 wk. For patients without any metastasis in the neck lymph nodes or with suspicious ones (N0, N1a, N2a), 12% (4/33) developed cervical metastasis if the upper neck area was left untreated. Yet none of them developed metastasis if the neck was treated prophylactically either by radiation (3000-4000 rad/3-4 wk) or by surgery. For patients with positive neck lymph nodes (N1b, N2b, N3), surgery was better than radiation (4000-6000 rad/4-6 wk).

Carcinoma of the oral cavity. Selective management according to site and stage

The treatment philosophy of carcinoma of the oral cavity is explained. Specific guidelines for therapy of various head and neck sites are offered as a rational approach to formulation of individual treatment programs.

The use of transarterial microembolization in the management of hemangiomas of the perioral region

The management of oral and perioral hemangiomas depends on several clinical factors. Surgery of these benign lesions can at times be disfiguring, especially when the lips, muscles, or the maxilla and mandible are involved. In addition, by the very nature of these lesions, surgical treatment may be associated with excessive intra- and perioperative blood loss. A series of five patients who had hemangiomas in the perioral region and who were initially treated with transarterial microembolization, preoperatively in two cases and as the only treatment in three cases, is presented. The technique of microembolization is described and recommendations for its use are given.

Carcinoma of the lip. A retrospective study of 70 patients

From 1966 to 1978, 70 patients with carcinoma of the lip were treated at the Division of Plastic Surgery, University Central Hospital, Helsinki. The lip tumour was a squamous cell carcinoma in 64 patients, and a basal cell carcinoma in 6 patients. Of these 70 patients, 24 had radiotherapy as the primary mode of therapy and 46 patients had been treated initially by surgery. The results of surgery were generally good. However, in the group of "simple wedge excision" and in patients who had had radiotherapy as the primary treatment there was a higher incidence of recurrences. In the former group the recurrences were considered to be due to a too narrow angle of excision. We recommend surgery as the primary method of treatment because of the availability of histologically accurate tumour margin assessment, the short rehabilitation period and the good functional results achieved.

Complications of embolization treatment for problem cavernous hemangiomas

Radiologists trained in selective angiography can now deliver sclerosing or occluding materials to the arterial supply of vascular tumors. Such skills require special training and there are limitations to the use of these materials. Specific obliteration can be carried out if this technique is quality controlled. Materials being used for embolization are continually being studied and are changing as new materials are developed. Radiologists can assist surgeons in managing some of these very difficult problems. A large series of patients with various vascular lesions treated at the Oregon Health Sciences University was reviewed. The complications of embolization used for cavernous hemangiomas have tempered our enthusiasm for it as an adjunct form of therapy. We do feel that this method of treatment remains useful in selected cases. The occlusion achieved caused a decrease in both symptoms and size of lesions treated. The decrease in size excluded the need for surgery in 3 cases, aided resection in 1, but caused significant complicating slough in 1. Five cases are presented to demonstrate problems of tissue necrosis encountered.

[Clinical picture, therapy and prognosis of orolabial cancer with special reference to regional lymphatic drainage]

Upon classification according to the TNM system, most lip carcinomas fell into low T-categories whereas cancers of the oral cavity fell in high T-categories. The proportion of cases with palpable lymph nodes did not differ between the two sites although the extent of the palpation findings (N-category) did differ. In general differences in clinical behavior between the two locations were more apparent when a complex evaluation of all findings was undertaken. Lymph node metastases were divided into two categories whereby a more differentiated calculation of the frequency of metastasis was possible. The interpretability and accuracy of the palpation findings of regional lymph nodes corresponding to the TNM-classification is rather limited with respect to the occurrence of metastases. Patients with fixed lymph nodes or histologically confirmed or clinically certain metastases have a poor prognosis. The frequency of appearence of temporally-determined recurrences and late metastases as well as the average interval until appearence were essentially the same.