Nonmelanoma skin cancer of the head and neck: surgical treatment

Use of Total Auricular Fillet Flap to Reconstruct Defects After Auricular and Parotid Region Tumors

PURPOSE

The auricular fillet flap (AFF) is also used to reconstruct defects of the periauricular region and scalp.The aim of this study was to evaluate patients in whom the total AFF was used to reconstruct defects formed after the resection the skin of the auricular and parotid regions.

METHODS

Seven patients, who presented at the researchers' hospital between January 2017 and July 2020 with masses involving, to different degrees, the parotid region, the periauricular region, the external auditory canal, or the auricular anterior surface skin were retrospectively evaluated.

RESULTS

The study retrospectively analyzed seven patients aged 71 to 92 (mean: 80.3 years), including two females (28.5%) and five males (71.5%). The defective region, formed as a result of surgery, was reconstructed with the TAFF in all patients. One patient developed a blood circulation deficiency at first but recovered within a week, while there were no problems with blood circulation or compatibility of the flaps in the other six patients.

CONCLUSION

The researchers recommend using the TAFF as an alternative flap for reconstructing defects of the skin of the auricular and parotid regions. This reconstruction method can be achieved in one session and offers acceptable aesthetic results.

The Role of Resection of the Outer Table of the Cranium in Locally Invasive Primary Squamous Cell Carcinoma of the Scalp

INTRODUCTION

Nonmelanoma skin cancer is the most common malignancy of the scalp. Of these, squamous cell carcinoma (SCC) is the most troublesome. It poses a challenge to the surgeons caring for these patients as the anatomy of the scalp makes excision and reconstruction difficult. Although more superficial lesions are amenable to Mohs micrographic surgery, more invasive lesions require a different approach. This manuscript is a retrospective review of outer table resection for SCC of the scalp invading to the depth of the pericranium. We include a discussion of full thickness craniectomy for invasive SCC, regardless of depth of invasion, for completeness.

METHODS

IRB approval was obtained from St. Joseph's Hospital and Medical Center in Phoenix, Arizona. One hundred four potential cases identified based on ICD codes. Ultimately, 23 cases met study criteria and were included in this analysis. Seventeen cases of outer table resection and 6 cases of full craniectomy were discussed. Additionally, the authors' approach for resection and reconstruction is articulated.

RESULTS

Seventeen patients underwent outer table resection at an average age of 79.3 years. All had invasion of the pericranium with a mean surface area of 42.6 cm2. Eight patients had prior radiation treatment for SCC of the scalp and 12 patients had at least 1 prior surgery to attempt excision of their lesions. Two patients had local recurrence for a local control rate of 88.2% (15/17). One patient with metastasis prior to presentation, died 6 months after his initial surgery for disease-free survival rate of 94.1% (16/17) at a mean of 15.4months. Thirteen patients were able to achieve immediate reconstruction with local flaps with or without additional skin grafting (76.5%).

DISCUSSION

The data in this study supports that in instances of locally invasive primary SCC of the scalp that extends to the pericranium, excision down to the calvarium with complete circumferential and deep peripheral margin assessment, followed by resection of the outer table, is an excellent option. The low rate of local recurrence and high disease-free survival in this study support that this method allows for optimal oncologic outcome while mitigating the significant morbidity associated with the alternative option of a full thickness craniectomy.

Complex skin cancer treatment requiring reconstructive plastic surgery: an interview study on the experiences and needs of patients

To provide patient-centered care, it is essential to explore what patients consider important and to adjust care accordingly. This may specifically be relevant for patients with complex skin cancer, for whom the care process is often more complicated and psychological and social problems may play a larger role. The objective was to explore the experiences and needs of patients who had undergone surgical treatment by a dermatologist for a complex skin cancer with a subsequent reconstruction by a plastic surgeon. An interview study was conducted among 16 patients who had undergone surgical treatment by a dermatologist and reconstruction by a plastic surgeon for basal cell carcinoma, cutaneous squamous cell carcinoma, or lentigo maligna. The interviews focused on patients’ experiences and needs regarding care using a predefined topic list. All interviews were audio-taped, transcribed verbatim and inductively analyzed using Atlas.ti. Patients reported a need for a skilled and friendly physician who tailors information and communication to their individual situation. A need for continuity of care and improved collaboration between healthcare providers was also emphasized. Furthermore, patients experienced complications and unmet expectations and expressed a need for shared decision-making at various steps throughout the treatment process (depending on age). Patients also considered completeness of tumor removal, follow-up visits with multiple specialists to be planned the same day and recognition of the psychological impact of the disease on the partner important. To improve patient-centered care for complex skin cancer patients, more efforts should be directed towards improving continuity of care and collaboration. Furthermore, it is advocated for physicians to be sensitive to the individual needs of patients and their partner and adjust information, communication and (supportive) care accordingly.

Nonmelanoma Facial Skin Cancer: A Review of Diagnostic Strategies, Surgical Treatment, and Reconstructive Techniques

Nonmelanoma skin cancer is the most common form of cancer in the United States, and the face is a common area for skin cancer development due to its frequent exposure to the sun. This article focuses on the surgical management of facial nonmelanoma skin cancers, including diagnostic considerations, biopsy techniques, and staging. In addition, we discuss surgical treatment options, including indications, techniques, outcomes, and facial reconstruction following tumor excision.

Reconstruction of facial soft tissue: comparison between conventional procedures and the facelift technique

We compared the result of replacement using a modified facelift technique with those of other commonly used surgical techniques for the treatment of defects of the soft tissue of the infraorbital and cheek region. We made a retrospective observational study of 86 patients who had defects of the facial soft tissue after excision of malignant tumours. Procedures used for reconstructions included non-vascularised skin grafts, local flaps, facelift technique, and microvascular free flaps, and we evaluated morbidity; duration of hospital stay; the need for, and duration of stay in the intensive care unit (ICU); and functional and aesthetic outcomes. We studied 46 men and 40 women (mean (range) age 71 (8-99) years). We found no significant difference between the methods apart from shorter duration of hospital stay and lower incidence of ectropion in the facelift group. The facelift technique also gave the best aesthetic outcome. However, in defects larger than 60cm², microvascular free tissue transfer was the only choice. The facelift technique is reliable and safe, and gives excellent aesthetic and functional outcomes, but its use is limited to defects smaller than 60cm².

Identifying locally advanced basal cell carcinoma eligible for treatment with vismodegib: an expert panel consensus

ABSTRACT 

Basal cell carcinoma (BCC) is the most common skin cancer worldwide. Most occur on the head and neck, where cosmetic and functional outcomes are critical. BCC can be locally destructive if not diagnosed early and treated appropriately. Surgery is the treatment of choice for the majority of high-risk lesions. Aggressive, recurrent or unresectable tumors can be difficult to manage. Until recently, no approved systemic therapy was available for locally advanced or metastatic BCC inappropriate for surgery or radiotherapy. Vismodegib provides a systemic treatment option. However, a consensus definition of advanced BCC is lacking. A multidisciplinary panel with expertise in oncology, dermatology, dermatologic surgery and radiation oncology proposes a consensus definition based on published evidence and clinical experience.

Reconstructive surgery in advanced perioral non-melanoma skin cancer. Results in elderly patients

BACKGROUND

Nonmelanoma skin cancer (NMSC) of the perioral region is not uncommon. Basal cell carcinoma is predominant in the upper lip area and squamous cell carcinoma in the lower lip area. While smaller lesions can be treated by excision followed by primary closure larger defects after tumor surgery can be challenging.

OBJECTIVES

Analysis of outcome after complete surgical excision with micrographical control of excision margins (delayed Mohs surgery) of large NMSC's of the perioral region (lips and chin).

PATIENTS AND METHODS

This is a retrospective, single-center analysis of patients with defects after delayed Mohs surgery of ≥ 3 cm of the perioral region. The study included a total of 25 patients (4 women and 21 men) with a mean age of 83.7 years. Twenty patients were diagnosed with squamous cell carcinoma and five had basal cell carcinoma. The lower lip was affected in 19 patients, the upper lip in 4 patients and the chin in 2 patients. Tumor stage was either T1N0M0 or T2N0M0. The most common procedure for lower lip defect closure was staircase or modified staircase technique. Cheek advancement flaps were used for upper lip defect closure. Inferiorly based nasolabial rotational flap, cheek rotational flap and modified Webster flap were also employed. In one patient Webster flap and unilateral staircase technique were combined.

RESULTS

In all patients the tumor was removed completely with preservation of function and aesthetics. No local recurrence was observed after a median follow-up of 4.9 years.

CONCLUSION

Perioral reconstruction after removal of large NMSC is a complex issue. The age group of over 70 years, frequently with comorbidities, requires a robust surgical technique with short operation times and tailored approaches for defect closure.

Simulation-Based Rhomboid Flap Skills Training During Medical Education

OBJECTIVE

To assess if the bench model fidelity interferes in the acquisition of rhomboid flap skills by medical students.

METHODS

Sixty novice medical students were randomly assigned to 5 practice conditions with instructor-directed Limberg rhomboid flap skills training: didactic materials (control group 1), low-fidelity rubberized line (group 2) or ethylene-vinyl acetate (group 3) bench models; high-fidelity chicken leg skin (group 4) or pig foot skin (group 5) bench models. Pretests and posttests were applied, and Global Rating Scale, effect size, and self-perceived confidence were used to evaluate all flap performances.

RESULTS

Medical students from groups 2 to 5 showed better flap performances based on the Global Rating Scale (all P < 0.05) and felt more confident to perform rhomboid flaps (all P < 0.05) compared to their peers from control group 1, regardless of bench model fidelity (all P > 0.05). The magnitude of the effect was considered large (>0.80) in all measurements.

CONCLUSION

There was acquisition of rhomboid flap skills regardless of bench model fidelity.