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Rowse BM, Yu ACX, Faulkner H, Sandler G, Howle JR, Ch'ng S, Rao PJ, Varey AHR. Does preoperative imaging for scalp non-melanocytic skin cancer accurately predict invasion of the cranial vault? A systematic review and meta-analysis. ANZ J Surg 2023; 93:1970-1977. [PMID: 37303266 DOI: 10.1111/ans.18566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE This study aimed to determine the diagnostic accuracy of CT and MRI in the preoperative detection of bone involvement for non-melanoma skin cancers (NMSCs) located on the scalp. This study further aimed to evaluate the predictive value of these imaging modalities in determining the need for craniectomy and to identify gaps in the existing literature. METHODS Electronic searches of the MEDLINE, Embase, Cochrane and Google Scholar databases were performed for English language studies of any type. Studies reporting detection or exclusion of histopathologically confirmed bone involvement through preoperative imaging were identified according to PRISMA guidelines. Studies reporting dural involvement, non-scalp tumours, and lacking tumour type(s) or outcome data were excluded. Outcomes were preoperative imaging result and histopathologically confirmed bone invasion. Meta-analysis was performed and sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated (excluding case report and MRI data due to insufficient quality and quantity respectively). RESULTS Four studies with a total of 69 patients were included in the final review, of which two studies totalling 66 patients were included in the meta-analysis. Preoperative CT had a sensitivity of 38%, specificity of 98%, PPV of 90% and NPV of 73%. CONCLUSIONS The available data suggests that a preoperative CT finding of calvarial involvement by a scalp NMSC is likely to be real, but the absence of such a finding is unreliable. Current evidence suggests that preoperative imaging cannot exclude the necessity for craniectomy and future research is needed, particularly on the role of MRI.
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Affiliation(s)
- Benjamin M Rowse
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Ann C X Yu
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Harrison Faulkner
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Gideon Sandler
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Julie R Howle
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Sydney Ch'ng
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Department of Plastic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Sydney Head & Neck Cancer Institute, Chris O'Brien Lifehouse Cancer Institute, Sydney, New South Wales, Australia
| | - Prashanth J Rao
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, New South Wales, Australia
| | - Alexander H R Varey
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Department of Plastic Surgery, Westmead Hospital, Sydney, New South Wales, Australia
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Gupta N, Ruiz ES. Current Perspectives in the Treatment of Locally Advanced Basal Cell Carcinoma. Drug Des Devel Ther 2022; 16:183-190. [PMID: 35058688 PMCID: PMC8765439 DOI: 10.2147/dddt.s325852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 01/06/2022] [Indexed: 12/30/2022] Open
Abstract
Basal cell carcinoma (BCC) is the most common cancer in Caucasians, and its incidence continues to rise. Generally, BCCs have good outcomes when diagnosed and treated early. However, 1-10% of patients will develop advanced disease due to either delays in accessing treatment or aggressive tumors that may be refractory to treatment. Locally advanced basal cell carcinomas (laBCCs) are large, aggressive, or recurrent tumors that have the potential to invade surrounding tissues including bone, cartilage, nerve, and muscle. Treatment requires a multi-disciplinary approach where different modalities including surgery, radiation therapy, Hedgehog Pathway Inhibitors, and immunotherapy can be considered.
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Affiliation(s)
- Neha Gupta
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Jamaica Plain, MA, USA
| | - Emily S Ruiz
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Jamaica Plain, MA, USA
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3
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Monroe M, Kakarala K. Management of Advanced Basal Cell Carcinoma of the Head and Neck. Otolaryngol Clin North Am 2021; 54:271-280. [PMID: 33743886 DOI: 10.1016/j.otc.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Basal cell carcinoma is the most common human malignancy, with an incidence exceeding all other cancers combined. Advanced basal cell cancer requires a multidisciplinary approach to management. The mainstay of treatment remains surgical excision with appropriate reconstruction. Some advanced tumors may require radical resections; however, extensive, high-risk surgery may be justified by the indolent biology of the disease and the likelihood of cure. Other options, such as radiation or systemic targeted therapy, may be considered in selected patients who either refuse or are not candidates for surgery. The focus of this article is primarily on management of these high-risk cases.
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Affiliation(s)
- Marcus Monroe
- Head and Neck Surgery, Head and Neck Clinical Trials Program, Head and Neck Disease-Oriented Team, Huntsman Cancer Institute, University of Utah School of Medicine, 2000 Circle of Hope Drive, Salt Lake City, UT 84132, USA.
| | - Kiran Kakarala
- Head and Neck Surgery and Microvascular Reconstruction, Head and Neck Fellowship, Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; Department of Health Policy and Management, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
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4
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Breen JT, Roberts DB, Gidley PW. Basal cell carcinoma of the temporal bone and external auditory canal. Laryngoscope 2017; 128:1425-1430. [PMID: 28850700 DOI: 10.1002/lary.26785] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/04/2017] [Accepted: 06/08/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To review the presenting features, treatment, and outcomes for patients with basal cell carcinoma (BCC) involving the temporal bone or external auditory canal (EAC). STUDY DESIGN Retrospective case series. METHODS Presenting characteristics, treatment strategies, and outcomes for patients with BCC involving the temporal bone or EAC were reviewed. Main outcome measures included rates of overall and disease-free survival at 5 years. RESULTS Forty-two patients met the inclusion criteria (mean age, 67 years). The most common presenting symptoms were hearing loss (15 patients, 36%) and otorrhea (11 patients, 26%). The 5-year overall survival rate was 78%, and the 5-year disease-free survival rate was 77%. Patients who had undergone surgery elsewhere and presented with facial weakness had significantly worse overall survival (P = .004). Ten patients (24%) underwent sacrifice of at least a portion of the facial nerve at the time of their initial procedure at our institution. Two patients (5%) developed regional nodal disease. There was a trend toward better disease-free survival for patients who received adjuvant radiation therapy after surgery at our institution (P = .06). CONCLUSIONS BCC originating from or extending to the temporal bone can exhibit a wide range of behavior, ranging from superficial lesions readily managed with surgery to extensive locally invasive tumors with propensity for recurrence, treated with multimodality therapy. BCC may be associated with better prognosis than other temporal bone malignancies. LEVEL OF EVIDENCE 4. Laryngoscope, 128:1425-1430, 2018.
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Affiliation(s)
- Joseph T Breen
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Dianna B Roberts
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Paul W Gidley
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
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5
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Brunner M, Ch'ng S, Shannon K, Clifford A, Ashford B, Elliott M, Clark JR. Bone resection for facial cutaneous malignancies. J Surg Oncol 2017. [PMID: 28628727 DOI: 10.1002/jso.24693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study is to analyze the clinical outcomes of patients who underwent bone resection for cutaneous malignancy of the face and scalp. METHODS We retrospectively collected patient data from 62 patients who underwent bone resection for craniofacial cutaneous malignancy of the face and scalp over the last 10 years. We investigated risk factors for disease progression and assessed the utility of pre-operative imaging to predict bone, dura, and brain infiltration. RESULTS Out of all factors analyzed, brain invasion, surgical margin involvement, and dural margin involvement were found to significantly reduce survival. CT and MRI correctly predicted bone infiltration in 88% and 89% of cases. MRI correctly predicted dura invasion in 89% but grossly underestimated the amount of dural invasion in 23% of reports. CONCLUSIONS Our data indicate that the resection of bone is a reasonable surgical option in the treatment of patients with advanced cutaneous malignancies of the face and scalp. Brain invasion and positive margins reduced the probability of survival.
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Affiliation(s)
- Markus Brunner
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.,Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Sydney Ch'ng
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Kerwin Shannon
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Anthony Clifford
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Bruce Ashford
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Michael Elliott
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.,Central Clinical School, University of Sydney, Camperdown, New South Wales, Australia
| | - Jonathan R Clark
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.,Central Clinical School, University of Sydney, Camperdown, New South Wales, Australia
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Skulsky SL, O'Sullivan B, McArdle O, Leader M, Roche M, Conlon PJ, O'Neill JP. Review of high‐risk features of cutaneous squamous cell carcinoma and discrepancies between the American Joint Committee on Cancer and NCCN Clinical Practice Guidelines In Oncology. Head Neck 2016; 39:578-594. [DOI: 10.1002/hed.24580] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 07/13/2016] [Accepted: 08/02/2016] [Indexed: 01/23/2023] Open
Affiliation(s)
| | - Barry O'Sullivan
- Department of Plastic and Reconstructive SurgeryBeaumont HospitalDublin Ireland
| | - Orla McArdle
- St. Luke's Radiation Oncology Network, Beaumont HospitalDublin Ireland
| | - Mary Leader
- Department of PathologyRoyal College of Surgeons in IrelandDublin Ireland
| | - Muireann Roche
- Department of DermatologyBeaumont Hospital and Royal College of Surgeons in IrelandDublin Ireland
| | - Peter J. Conlon
- Department of Nephrology and Renal TransplantationBeaumont Hospital and Royal College of Surgeons in IrelandDublin Ireland
| | - James Paul O'Neill
- Department of Neurosciences, Otolaryngology and Cochlear ImplantRoyal College of Surgeons in Ireland, Beaumont HospitalDublin Ireland
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Raza SM, Ramakrishna R, Weber RS, Kupferman ME, Gidley PW, Hanna EY, DeMonte F. Nonmelanoma cutaneous cancers involving the skull base: outcomes of aggressive multimodal management. J Neurosurg 2015; 123:781-8. [PMID: 25909577 DOI: 10.3171/2014.10.jns141037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT A relative paucity of information exists regarding outcomes from craniofacial resection for advanced nonmelanoma skin cancers involving the skull base. In light of advances in surgical technique and adjuvant therapy protocols, the authors reviewed their surgical experience to determine disease control rates, overall survival (OS), morbidity, and mortality. METHODS A retrospective review of 24 patients with nonmelanoma cutaneous cancers with skull base involvement treated with craniofacial resection at The University of Texas MD Anderson Cancer Center from 1994 to 2012 was performed. Of these patients, 19 (79%) had squamous cell carcinoma (SCC), 4 (17%) had basosquamous carcinoma (BSCC), and 1 patient (4%) had adenocarcinoma. Factors as assessed were prior treatment, TNM staging, tumor involvement, extent of intracranial extension, margin status, postoperative complications, recurrence, disease status at last follow-up, and long-term survival. The majority of tumors were T4 (67%) according to the TNM classification; perineural extension was noted in 58%, cavernous sinus involvement in 25%, and dural involvement in 29%. RESULTS Postoperative complications occurred in 4 patients (17%) including 1 death. Kaplan-Meier estimates were calculated for OS and progression-free survival (PFS). Median OS was 43.2 months with an 82% 1-year OS and 37% 5-year OS; the median PFS was 91.2 months. Margin status was positively associated with median OS in SCC (91 months [for negative margins] vs 57 months, p = 0.8) and in BSCC (23.7 vs 3.2 months, p < 0.05). Postoperative radiotherapy was associated with improved median OS (43.2 vs 22 months, p = 0.6). Brain involvement was uniformly fatal after 1 year, while cavernous sinus involvement (31 vs 43 months, p = 0.82), perineural disease (31 vs 54 months, p = 0.30), and T4 stage (22 vs 91.2 months, p = 0.09) were associated with worsened OS. Similar associations were found with median PFS. CONCLUSIONS Aggressive multimodality management with surgery and postoperative radiotherapy can positively impact locoregional control and OS. With improvements in technique and adjuvant therapy protocols, treatment can still be considered in situations of perineural disease and cavernous sinus involvement and as a salvage option for patients in whom prior treatment has failed. As patients with advanced NMSCs often have few options, craniofacial resection, as part of a coordinated multimodal management plan, is justified if it can be performed safely.
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Affiliation(s)
| | | | - Randal S Weber
- Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael E Kupferman
- Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paul W Gidley
- Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ehab Y Hanna
- Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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8
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Puig S, Berrocal A. Management of high-risk and advanced basal cell carcinoma. Clin Transl Oncol 2015; 17:497-503. [PMID: 25643667 PMCID: PMC4495248 DOI: 10.1007/s12094-014-1272-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 12/22/2014] [Indexed: 01/18/2023]
Abstract
Despite that basal cell carcinoma (BCC) is curative in the vast majority of cases, some patients are at high risk of recurrence and, in a few patients, lesions can progress to a point unsuitable for local therapy and prognosis is quite poor. The aim of the present work is to review clinical and pathologic characteristics as well as classical and new treatment options for high-risk, metastatic and locally advanced BCC. Surgery and radiotherapy remain the selected treatments for the majority of high-risk lesions. However, some patients are located on a blurry clinical boundary between high-risk and locally advanced BCC. Treatment of these patients is challenging and need an individualized and highly specialized approach. The treatment of locally advanced BCC, in which surgery or radiotherapy is unfeasible, inappropriate or contraindicated, and metastatic BCC has changed with new Hedgehog pathway inhibitors of which vismodegib is the first drug approved by FDA and EMA.
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Affiliation(s)
- S Puig
- Melanoma Unit, Dermatology Department, Hospital Clínic Barcelona, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain,
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9
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McRackan TR, Fang TY, Pelosi S, Rivas A, Dietrich MS, Wanna GB, Labadie RF, Haynes DS, Bennett ML. Factors associated with recurrence of squamous cell carcinoma involving the temporal bone. Ann Otol Rhinol Laryngol 2014; 123:235-9. [PMID: 24671478 DOI: 10.1177/0003489414524169] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aimed to better identify factors associated with recurrence of squamous cell carcinoma (SCC) involving the temporal bone. METHODS A retrospective study was conducted at a tertiary hospital. Sixty patients who were diagnosed over a 10-year period with SCC involving the temporal bone and underwent surgical resection were analyzed. All patients were staged based on the University of Pittsburgh staging system. Demographic, intraoperative, and pathologic data were analyzed with respect to recurrence. RESULTS Thirteen (21.7%) patients were T1, 8 (13.3%) T2, 7 (11.7%) T3, and 32 (53.3%) T4. Eighteen patients (30.0%) recurred in the study period. The mean time to recurrence was 5.8 months. Tumors originating in the skin overlying the parotid gland and the external auditory canal had higher recurrence rates than those from the auricle/postauricular skin and temporal bone (P = .05). Direct parotid and perineural spread accounted for 15.0% of all routes of temporal invasion but resulted in 22.2% of all recurrences (P = .04). Increased N stage was statistically associated with increased risk of recurrence (P = .01). Cervical, as compared to perifacial and parotid, lymph node involvement was associated with increased risk of recurrence (odds ratio = 6.91; 95% confidence interval, 1.11-42.87). CONCLUSION We have identified multiple factors that are associated with increased recurrence of SCC involving the temporal bone.
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Affiliation(s)
- Theodore R McRackan
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Gencoglan G, Ozdemir F. Nonmelanoma Skin Cancer of the Head and Neck. Facial Plast Surg Clin North Am 2012; 20:423-35. [DOI: 10.1016/j.fsc.2012.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Mendenhall WM, Ferlito A, Takes RP, Bradford CR, Corry J, Fagan JJ, Rinaldo A, Strojan P, Rodrigo JP. Cutaneous head and neck basal and squamous cell carcinomas with perineural invasion. Oral Oncol 2012; 48:918-922. [DOI: 10.1016/j.oraloncology.2012.02.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 02/15/2012] [Accepted: 02/17/2012] [Indexed: 10/28/2022]
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Balamucki CJ, Mancuso AA, Amdur RJ, Kirwan JM, Morris CG, Flowers FP, Stoer CB, Cognetta AB, Mendenhall WM. Skin carcinoma of the head and neck with perineural invasion. Am J Otolaryngol 2012; 33:447-54. [PMID: 22185685 DOI: 10.1016/j.amjoto.2011.11.004] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 11/04/2011] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of the study was to update the experience treating cutaneous squamous cell and basal cell carcinomas of the head and neck with incidental or clinical perineural invasion (PNI) with radiotherapy (RT). MATERIALS AND METHODS From 1965 to 2007, 216 patients received RT alone or with surgery and/or chemotherapy. RESULTS The 5-year overall, cause-specific, and disease-free survivals for incidental and clinical PNIs were 55% vs 54%, 73% vs 64%, and 67% vs 51%. The 5-year local control, local-regional control, and freedom from distant metastases for incidental and clinical PNIs were 80% vs 54%, 70% vs 51%, and 90% vs 94%. On univariate and multivariate (P = .0038 and .0047) analyses, clinical PNI was a poor prognostic factor for local control. The rates of grade 3 or higher complication in the incidental and clinical PNI groups were 16% and 36%, respectively. CONCLUSIONS Radiotherapy plays a critical role in the treatment of this disease. Clinical PNI should be adequately irradiated to include the involved nerves to the skull base.
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Affiliation(s)
- Christopher J Balamucki
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, USA
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14
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[Advanced skin tumors (incurables?) of the cephalic extremity: surgical considerations]. ANN CHIR PLAST ESTH 2012; 57:533-41. [PMID: 22742993 DOI: 10.1016/j.anplas.2012.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Accepted: 05/18/2012] [Indexed: 01/01/2023]
Abstract
Suggest a surgical thinking for a multidisciplinary problem is inevitably difficult. Nevertheless, through targeted clinical examples, we tried to prioritize our clinical and intellectual approach for advanced tumors of the cephalic extremity. In these cases, decisions can only be collegial, and respect for the patient and his choices remain essential. Ultimately, we would argue this problematic, discussing successively the histological type, ethical concern with regard to clinic, operability and reconstruction opportunities.
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Kalani MYS, Kalani MA, Kalb S, Albuquerque FC, McDougall CG, Nakaji P, Spetzler RF, Porter RW, Feiz-Erfan I. Craniofacial approaches to large juvenile angiofibromas. J Neurosurg Pediatr 2011; 8:71-8. [PMID: 21721892 DOI: 10.3171/2011.4.peds10514] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Craniofacial approaches provide excellent exposure to lesions in the anterior and middle cranial fossae. The authors review their experience with craniofacial approaches for resection of large juvenile nasopharyngeal angiofibromas. METHODS Between 1992 and 2009, 22 patients (all male, mean age 15 years, range 9-27 years) underwent 30 procedures. These cases were reviewed retrospectively. RESULTS Gross-total resection of 17 (77%) of the 22 lesions was achieved. The average duration of hospitalization was 8.2 days (range 3-20 days). The rate of recurrence and/or progression was 4 (18%) of 22, with recurrences occurring a mean of 21 months after the first resection. All patients underwent preoperative embolization. Nine patients (41%) developed complications, the most common of which was CSF leakage (23%). The average follow-up was 27.7 months (range 2-144 months). The surgery-related mortality rate was 0%. Based on their mean preoperative (90) and postoperative (90) Karnofsky Performance Scale scores, 100% of patients improved or remained the same. CONCLUSIONS The authors' experience shows that craniofacial approaches provide an excellent avenue for the resection of large juvenile nasopharyngeal angiofibromas, with acceptable rates of morbidity and no deaths.
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Affiliation(s)
- M Yashar S Kalani
- Division of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona 85013, USA
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16
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Gil Z, Patel SG, Cantu G, Fliss DM, Kowalski LP, Singh B, Snyderman C, Kraus DH, Shah JP, Bridger PG, Cheesman AD, Donald P, Gullane P, Janecka I, Kamata SE, Levine PA, Medina LR, Pradhan S, Schramm V, Wei WI. Outcome of craniofacial surgery in children and adolescents with malignant tumors involving the skull base: an international collaborative study. Head Neck 2009; 31:308-17. [PMID: 19073003 DOI: 10.1002/hed.20958] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The aim of the study was to characterize the distribution of anterior skull base (ASB) cancers in the pediatric population and to identify predictors of outcome. METHODS This was an international study of 1307 patients undergoing craniofacial surgery for malignant tumors; 6.4% (n = 84) among these were <or=21 years old. RESULTS The most common histologic type was sarcoma (40%), followed by squamous cell carcinoma (14%). Higher incidence of tumors was found in older children (7.5-21 years) compared to younger children. The 5-year disease-specific and overall survival rates were 61% and 55%, respectively (median follow-up of 30 months). The best prognosis was associated with low-grade sarcomas and the worst with salivary and squamous cell carcinomas. High-grade sarcoma represented an intermediate risk group. On multivariate analysis, prior radiotherapy and histology were independent predictors of survival. CONCLUSION Surgery for malignant tumors involving the ASB is feasible and safe in children. Histology is significant determinant of poor outcome in this population.
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Affiliation(s)
- Ziv Gil
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
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McGuire JF, Ge NN, Dyson S. Nonmelanoma skin cancer of the head and neck I: histopathology and clinical behavior. Am J Otolaryngol 2009; 30:121-33. [PMID: 19239954 DOI: 10.1016/j.amjoto.2008.03.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 03/08/2008] [Indexed: 01/03/2023]
Abstract
Non-Melanoma skin cancer (NMSC) is the most commonly encountered malignancy in almost every area of practice, but the cases that present to an Otolaryngology practice will be advanced in nature. The major subtypes of NMSC include basal cell carcinoma, squamous cell carcinoma, dermatofibrosarcoma protuberans, merkel cell carcinoma, and adnexal malignancies. In this review, we present the epidemiology, histology, clinical presentation and management of these major subtypes. Further, we present background on multimodality treatment for NMSC lesions that have become metastatic from their primary site and an introduction to the behavior and treatment of NMSC lesions in patients who have received organ transplants. Understanding the clinical behavior of advanced NMSC is essential knowledge for a general Otolaryngologist.
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Affiliation(s)
- John F McGuire
- Department of Otolaryngology, Head and Neck Surgery, University of California, Irvine, CA 92618, USA
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18
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Mannor GE, Chern PL, Barnette D. Eyelid and periorbital skin basal cell carcinoma: oculoplastic management and surgery. Int Ophthalmol Clin 2009; 49:1-16. [PMID: 20348854 DOI: 10.1097/iio.0b013e3181b7ebe8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Geva E Mannor
- Division of Ophthalmology, Scripps Clinic, La Jolla, CA 92037, USA
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Abstract
This article represents a planned regular updating of the previous British Association of Dermatologists guidelines for the management of basal cell carcinoma. These guidelines present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation.
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Affiliation(s)
- N R Telfer
- Dermatology Centre, Salford Royal Hospitals NHS Foundation Trust, Manchester M6 8HD, UK.
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Snyderman CH, Carrau RL, Kassam AB, Zanation A, Prevedello D, Gardner P, Mintz A. Endoscopic skull base surgery: Principles of endonasal oncological surgery. J Surg Oncol 2008; 97:658-64. [DOI: 10.1002/jso.21020] [Citation(s) in RCA: 211] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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21
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Feiz-Erfan I, Suki D, Hanna E, DeMonte F. PROGNOSTIC SIGNIFICANCE OF TRANSDURAL INVASION OF CRANIAL BASE MALIGNANCIES IN PATIENTS UNDERGOING CRANIOFACIAL RESECTION. Neurosurgery 2007; 61:1178-85; discussion 1185. [DOI: 10.1227/01.neu.0000306095.53388.f1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Invasion of the brain and/or dura is a known negative prognostic factor for patients undergoing craniofacial resection for cranial base malignancy. However, an evaluation of factors that may affect prognosis in this patient subgroup has not been undertaken.
METHODS
Between 1993 and 2003, 212 patients underwent craniofacial resection for primary malignancy of the cranial base at the University of Texas M.D. Anderson Cancer Center. Twenty-eight patients (eight women, 20 men; median age, 52 yr; age range, 26–76 yr) had evidence of transdural spread (subdural tumor or brain invasion) of malignancy. These patients were identified and a retrospective review of prospectively collected data was undertaken.
RESULTS
Subdural tumors were found in 16 of these patients, and brain invasion was detected in 12. Gross total resections were achieved in 22 patients: 13 with microscopically negative margins, eight with positive margins, and one with unspecified margins. Surgical complications occurred in six patients. There was no surgical mortality. The 5-year actuarial overall survival (OS) was 58%. Eleven patients had no evidence of disease, 11 died of disease, and six were alive with disease at the end of the follow-up period. The median actuarial progression-free survival (PFS) was 38 months (95% confidence interval, 4–72 mo). Gross total resection with negative margins was the key positive predictor of OS and PFS. Brain invasion was a negative predictor of survival (significant for PFS; trend only for OS). There was a trend for shorter OS and PFS in patients with high-grade tumors.
CONCLUSION
Overall OS and PFS in highly selected patients with transdural invasion of cranial base malignancy is similar to what has been historically reported for patients without such invasion. The most important variables positively affecting OS and PFS seem to be the ability to achieve a microscopically margins-negative resection followed by absence of brain invasion. Performing this resection in a piecemeal fashion does not seem to affect survival outcomes.
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Affiliation(s)
- Iman Feiz-Erfan
- Department of Neurosurgery, The University of Texas, M.D. Anderson Cancer Center, Houston, Texas
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital, Phoenix, Arizona
| | - Dima Suki
- Department of Neurosurgery, The University of Texas, M.D. Anderson Cancer Center, Houston, Texas
| | - Ehab Hanna
- Department of Head and Neck Surgery, The University of Texas, M.D. Anderson Cancer Center, Houston, Texas
| | - Franco DeMonte
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital, Phoenix, Arizona
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22
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Maghami EG, Talbot SG, Patel SG, Singh B, Polluri A, Bridger PG, Cantu G, Cheesman AD, De Sa G, Donald P, dos Santos LRM, Fliss D, Gullane P, Janecka I, Kamata SE, Kowalski LP, Kraus DH, Levine PA, Pradhan S, Schramm V, Snyderman C, Wei WI, Shah JP. Craniofacial surgery for nonmelanoma skin malignancy: report of an international collaborative study. Head Neck 2007; 29:1136-43. [PMID: 17764086 DOI: 10.1002/hed.20656] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This study examined the efficacy of craniofacial surgery (CFS) in treating locally advanced nonmelanoma skin cancer (NMSC). METHODS One hundred twenty patients who underwent CFS for NMSC were identified from 17 participating institutions. Patient, tumor, and treatment information was analyzed for prognostic impact on survival. RESULTS Surgical margins were negative in 74%, close in 3%, and involved in 23% of patients. Complications occurred in 35% of patients, half of which were local wound problems. Operative mortality was 4%. Median follow-up interval after CFS was 27 months. The 5-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) rates were 64%, 75%, and 60%, respectively. Squamous cell histology, brain invasion, and positive resection margins independently predicted worse OS, DSS, and RFS. CONCLUSION CFS is an effective treatment for patients with NMSC invading the skull base. Histology, extent of disease, and resection margins are the most significant predictors of outcome.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Brain Neoplasms/mortality
- Brain Neoplasms/secondary
- Brain Neoplasms/surgery
- Carcinoma, Basal Cell/mortality
- Carcinoma, Basal Cell/pathology
- Carcinoma, Basal Cell/surgery
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Chemotherapy, Adjuvant
- Child
- Child, Preschool
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- International Cooperation
- Male
- Middle Aged
- Neoplasm Invasiveness
- Postoperative Complications
- Radiotherapy, Adjuvant
- Skin Neoplasms/mortality
- Skin Neoplasms/pathology
- Skin Neoplasms/surgery
- Skull Neoplasms/mortality
- Skull Neoplasms/secondary
- Skull Neoplasms/surgery
- Surgical Flaps
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Affiliation(s)
- Ellie G Maghami
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Mendenhall WM, Amdur RJ, Hinerman RW, Werning JW, Malyapa RS, Villaret DB, Mendenhall NP. Skin cancer of the head and neck with perineural invasion. Am J Clin Oncol 2007; 30:93-6. [PMID: 17278901 DOI: 10.1097/01.coc.0000251224.16075.60] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Perineural invasion occurs in 2% to 6% of cutaneous basal and squamous cell carcinomas of the head and neck and is associated with midface location, recurrent tumors, high histologic grade, and increasing tumor size. Patients may be asymptomatic with perineural invasion appreciated on pathologic examination of the surgical specimen (incidental) or may present with cranial nerve deficits (clinical). The cranial nerves most commonly involved are the 5th and 7th nerves. Magnetic resonance imaging is obtained to detect and define the extent of perineural invasion; computed tomography is used to detect regional lymph node metastases. Patients with apparently resectable cancers undergo surgery usually followed by postoperative radiotherapy. Patients with incompletely resectable cancers are treated with definitive radiotherapy. The 5-year local control, cause-specific survival, and overall survival rates are approximately 87%, 65%, and 50%, respectively, for patients with incidental perineural invasion compared with 55%, 59%, and 55%, respectively, for those with clinical perineural invasion.
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Affiliation(s)
- William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA.
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