1
|
Xu N, Sun Q. Neck management in metastatic cutaneous squamous cell carcinoma of the head and neck. Front Oncol 2024; 14:1344115. [PMID: 38487725 PMCID: PMC10937539 DOI: 10.3389/fonc.2024.1344115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
Objective Optimal neck management remains unclear in head and neck cutaneous squamous cell carcinoma (HNcSCC) with parotid metastasis. Our goal was to compare the impact of different cervical treatments on HNcSCC with parotid metastasis. Methods Patients were retrospectively included. The primary outcome variables were regional control (RC) and disease-specific survival (DSS). The impacts of observation, elective neck irradiation (ENI), and elective neck dissection (END) were analyzed using the Cox model and presented as hazard ratios (HRs) and 95% confidence intervals (CIs). Results In total, 268 patients were enrolled. In the Cox model for RC, compared with ENI, observation was associated with a significantly higher risk of regional recurrence (p = 0.001, HR = 2.50, 95%CI = 1.45-4.30). However, END showed a comparable influence on regional recurrence (p = 0.246, HR = 0.70, 95%CI = 0.38-1.28). In the Cox model for DSS, END demonstrated a similar HR of 0.62 (95%CI = 0.30-1.26) compared to ENI (p = 0.184). However, patients who underwent observation were associated with an additional nearly twofold risk of cancer-related mortality (HR = 2.85, 95%CI = 1.55-5.23). Subgroup analysis showed that ENI predicted comparable RC (p = 0.389) and DSS (p = 0.346) in patients with one or two metastatic parotid lymph nodes, but worse RC (p = 0.007) and DSS (p = 0.024) in patients with more than three positive lymph nodes. Conclusion In HNcSCC with parotid metastasis, elective treatment of neck lymph nodes with END or ENI should always be performed.
Collapse
Affiliation(s)
- Ning Xu
- Special Clinic, Henan Provincial Stomatological Hospital, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiang Sun
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
2
|
Qedair J, Haider AS, Balasubramanian K, Palmisciano P, Hassan T, Shahbandi A, Sabahi M, Kharbat AF, Abou-Al-Shaar H, Yu K, Cohen-Gadol AA, El Ahmadieh TY, Bin-Alamer O. Orbital Exenteration for Craniofacial Lesions: A Systematic Review and Meta-Analysis of Patient Characteristics and Survival Outcomes. Cancers (Basel) 2023; 15:4285. [PMID: 37686561 PMCID: PMC10487227 DOI: 10.3390/cancers15174285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/27/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND The outcomes of orbital exenteration (OE) in patients with craniofacial lesions (CFLs) remain unclear. The present review summarizes the available literature on the clinical outcomes of OE, including surgical outcomes and overall survival (OS). METHODS Relevant articles were retrieved from Medline, Scopus, and Cochrane according to PRISMA guidelines. A systematic review and meta-analysis were conducted on the clinical characteristics, management, and outcomes. RESULTS A total of 33 articles containing 957 patients who underwent OE for CFLs were included (weighted mean age: 64.3 years [95% CI: 59.9-68.7]; 58.3% were male). The most common lesion was squamous cell carcinoma (31.8%), and the most common symptom was disturbed vision/reduced visual acuity (22.5%). Of the patients, 302 (31.6%) had total OE, 248 (26.0%) had extended OE, and 87 (9.0%) had subtotal OE. Free flaps (33.3%), endosseous implants (22.8%), and split-thickness skin grafts (17.2%) were the most used reconstructive methods. Sino-orbital or sino-nasal fistula (22.6%), flap or graft failure (16.9%), and hyperostosis (13%) were the most reported complications. Regarding tumor recurrences, 38.6% were local, 32.3% were distant, and 6.7% were regional. The perineural invasion rate was 17.4%, while the lymphovascular invasion rate was 5.0%. Over a weighted mean follow-up period of 23.6 months (95% CI: 13.8-33.4), a weighted overall mortality rate of 39% (95% CI: 28-50%) was observed. The 5-year OS rate was 50% (median: 61 months [95% CI: 46-83]). The OS multivariable analysis did not show any significant findings. CONCLUSIONS Although OE is a disfiguring procedure with devastating outcomes, it is a viable option for carefully selected patients with advanced CFLs. A patient-tailored approach based on tumor pathology, extension, and overall patient condition is warranted.
Collapse
Affiliation(s)
- Jumanah Qedair
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah 22384, Saudi Arabia;
- King Abdullah International Medical Research Center (KAIMRC), Jeddah 22384, Saudi Arabia
| | - Ali S. Haider
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | - Paolo Palmisciano
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA 95819, USA
| | - Taimur Hassan
- Texas A&M School of Medicine, Texas A&M University, Houston, TX 77030, USA
| | - Ataollah Shahbandi
- Tehran School of Medicine, Tehran University of Medical Science, Tehran 1416634793, Iran
| | - Mohammadmahdi Sabahi
- Department of Neurological Surgery, Pauline Braathen Neurological Centre, Cleveland Clinic Florida, Weston, FL 33331, USA
| | | | - Hussam Abou-Al-Shaar
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15219, USA
| | - Kenny Yu
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Aaron A. Cohen-Gadol
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | | - Othman Bin-Alamer
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15219, USA
| |
Collapse
|
3
|
Park KS, Guo T, Liu CY. Cutaneous Squamous Cell Carcinoma With Orbital Extension. JAMA Ophthalmol 2022; 140:1133-1134. [PMID: 36201188 DOI: 10.1001/jamaophthalmol.2022.3919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A 72-year-old homeless man was referred for management of a recurrent cutaneous squamous cell carcinoma of the right temple and brow. He was seen again 5 months later with an enlarged crusting and ulcerating lesion of the right temple/brow. What would you do next?
Collapse
Affiliation(s)
- Kathryn S Park
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, La Jolla, California
| | - Theresa Guo
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego
| | - Catherine Y Liu
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, La Jolla, California
| |
Collapse
|
4
|
Melo GMD, Guilherme LH, Palumbo MDN, Rosano M, Neves MCD, Callegari FM, Abrahao M, Cervantes O. Parotidectomy and neck dissection in locally advanced and relapsed cutaneous squamous cell carcinoma of the head and neck region. Braz J Otorhinolaryngol 2022; 88 Suppl 4:S152-S162. [PMID: 35042657 DOI: 10.1016/j.bjorl.2021.11.007] [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: 08/24/2021] [Revised: 10/15/2021] [Accepted: 11/12/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate the prognostic factors to developing parotid and neck metastasis in locally advanced and relapsed Cutaneous Squamous Cell Carcinoma (CSCC) of the head and neck region. METHODS Single-center retrospective cohort study enrolling consecutive patients with advanced CSCC from 2009 to 2019. Seventy-four cases were identified. Study variables demographic data, clinical skin tumor stage, neck stage, parotid stage (P stage), surgical treatment features, and parotid, regional, and distant metastases. Survival measures: Overall Survival (OS) and Disease-Specific Survival (DSS). RESULTS The study group included 72.9% men (median age, 67 years); 67.5% showed T2/T3 tumors, 90.5% comorbidities, 20.2% immunosuppressed, with median follow-up: 35.8 months. The most frequent skin primary were auricular and eyelid regions, 75% underwent primary resection with flap reconstruction. Parotid metastasis was present in 50%, 32.4% showing parotid extracapsular spread, multivariate analysis found OR = 37.6 of positive parotid metastasis evolving into positive neck metastasis, p = 0.001. Occult neck metastasis, neck metastasis, and neck extracapsular spread were observed in 13.5%, 51.3%, and 37.8%, respectively. Kaplan-Meier survival: Clinical T4 versus T1, p = 0.028, P1 stage: 30% and 5% survival at 5 and 10 years, P3 stage: 0%, p = 0.016; OS and DSS showed negative survival for the parotid metastasis group, p = 0.0283. CONCLUSION Our outcomes support a surgically aggressive approach for locally advanced and relapsed CSCC, with partial parotidectomy for P0, total parotidectomy for P1-3, selective I-III neck dissection for all patients and adjuvant radiochemotherapy to appropriately treat these patients with advanced CSCC of the head and neck region. LEVEL OF EVIDENCE II b - Retrospective Cohort Study - Oxford Centre for Evidence-Based Medicine (OCEBM).
Collapse
Affiliation(s)
- Giulianno Molina de Melo
- Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil; Hospital Beneficência Portuguesa de São Paulo, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil.
| | - Luiz Henrique Guilherme
- Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Marcel das Neves Palumbo
- Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Marcello Rosano
- Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Murilo Catafesta das Neves
- Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil; Hospital Beneficência Portuguesa de São Paulo, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Fabiano Mesquita Callegari
- Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Patologia, São Paulo, SP, Brazil
| | - Marcio Abrahao
- Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil; Hospital Beneficência Portuguesa de São Paulo, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil; Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Patologia, São Paulo, SP, Brazil
| | - Onivaldo Cervantes
- Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| |
Collapse
|
5
|
Steren B, Burtness B, Bhatia A, Demirci H, Shinder R, Yoo D, Tse B, Pointdujour-Lim R. Cemiplimab for Orbital Squamous Cell Carcinoma in 11 Cases. Ophthalmic Plast Reconstr Surg 2022; 38:496-502. [PMID: 35502804 DOI: 10.1097/iop.0000000000002190] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To review the demographics, clinical features, and response of orbital squamous cell carcinoma treated with cemiplimab. METHODS This is a retrospective multi-institutional series. Patient characteristics, drug dosing, duration, and response to treatment were evaluated. RESULTS The study cohort consisted of 11 patients from 5 institutions. All patients received a regimen of 350 mg q 3 weeks and an average of 11.2 cycles (SD 5.8). No patient experienced significant side effects requiring treatment or cessation of cemiplimab. Complete response was achieved in 9 patients (82%) treated with cemiplimab. CONCLUSIONS Immune checkpoint inhibitors, such as cemiplimab provide a globe-sparing option for the treatment of orbital squamous cell carcinoma. It is important to consider these agents especially when orbital exenteration is the alternative.
Collapse
Affiliation(s)
- Benjamin Steren
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven
| | - Barbara Burtness
- Department of Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, U.S.A
| | - Aarti Bhatia
- Department of Internal Medicine, Yale Cancer Center, New Haven, CT, United States; Yale University School of Medicine, U.S.A
| | - Hakan Demirci
- Department of Ophthalmology and Visual Science, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Roman Shinder
- Department of Ophthalmology and Visual Science, SUNY Downstate, Brooklyn, New York, U.S.A
| | - David Yoo
- Department of Ophthalmology and Visual Science, Loyola University Medical Center, Maywood, Illinois, U.S.A
| | - Brian Tse
- Department of Ophthalmology and Visual Science, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, U.S.A
| | - Renelle Pointdujour-Lim
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven
- Yale Smilow Cancer Center, New Haven, CT, U.S.A
| |
Collapse
|
6
|
The Role of Resection of the Outer Table of the Cranium in Locally Invasive Primary Squamous Cell Carcinoma of the Scalp. J Craniofac Surg 2022; 33:1860-1864. [PMID: 35816753 DOI: 10.1097/scs.0000000000008696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/29/2022] [Indexed: 11/25/2022] Open
Abstract
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.
Collapse
|
7
|
Yung AE, Crouch G, Varey AHR, Lo S, Elliott MS, Lee J, Rawson R, Gupta R, Hong AM, Clark JR, Ch'ng S. Benchmarking Survival Outcomes Following Surgical Management of pT3 and pT4 Cutaneous Squamous Cell Carcinoma of the Head and Neck. Ann Surg Oncol 2022; 29:5124-5138. [PMID: 35419758 PMCID: PMC9246815 DOI: 10.1245/s10434-022-11669-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/11/2022] [Indexed: 12/19/2022]
Abstract
Background pT3/4 head and neck cutaneous squamous cell carcinomas (HNcSCCs) are associated with poor outcomes, including local recurrence, metastasis and death. Whilst surgery remains the standard treatment for advanced HNcSCC, novel systemic therapies, such as immunotherapy, are being used earlier in the treatment paradigm. It is imperative that the clinical outcomes of surgery are clearly described so that conventional and emerging treatment modalities can be better integrated and sequenced in the management of pT3/4 HNcSCC. Methods Patients with confirmed pT3/4 HNcSCC undergoing curative surgical resection between 2014-2020 were identified retrospectively from a prospectively maintained research database. The primary outcomes of interest were locoregional control (LRC), disease-specific survival (DSS), and overall survival (OS). The secondary outcome was surgical complication rate. Results A total of 104 patients (median age 74, range 41–94 years) were included, 90% of which had pT3 tumors; 36.5% received adjuvant radiotherapy. Median follow-up was 24.3 (range 1.0–84.3) months. LRC at 5 years was 62.0%, DSS at 5 years was 83.7%, and OS at 5 years was 71.9%. Median time to recurrence was 8.4 months. LRC was reduced in the presence of margin involvement and previous treatment (radiotherapy/surgery). The major surgical complication rate was 9.6%. Conclusions More than 60% of patients treated surgically for pT3/4 head and neck cSCC were alive and free of disease at 5 years posttreatment. High-risk features such as margin involvement and having had previous treatment (radiotherapy/surgery) should be used to guide adjuvant therapy.
Collapse
Affiliation(s)
- Amanda E Yung
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Royal Prince Alfred Hospital Institute of Academic Surgery, Camperdown, NSW, Australia
| | - Gareth Crouch
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Royal Prince Alfred Hospital Institute of Academic Surgery, Camperdown, NSW, Australia
| | - Alexander H R Varey
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Melanoma Institute Australia, University of Sydney, Sydney, NSW, Australia.,Department of Plastic and Reconstructive Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Serigne Lo
- Melanoma Institute Australia, University of Sydney, Sydney, NSW, Australia
| | - Michael S Elliott
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse Cancer Centre, Sydney, NSW, Australia
| | - Jenny Lee
- Department of Medical Oncology, Chris O'Brien Lifehouse Cancer Centre, Sydney, NSW, Australia
| | | | - Ruta Gupta
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,NSW Pathology, Sydney, NSW, Australia
| | - Angela M Hong
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Melanoma Institute Australia, University of Sydney, Sydney, NSW, Australia.,Department of Radiation Oncology, Chris O'Brien Lifehouse Cancer Centre, Sydney, NSW, Australia
| | - Jonathan R Clark
- Royal Prince Alfred Hospital Institute of Academic Surgery, Camperdown, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse Cancer Centre, Sydney, NSW, Australia
| | - Sydney Ch'ng
- Royal Prince Alfred Hospital Institute of Academic Surgery, Camperdown, NSW, Australia. .,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. .,Melanoma Institute Australia, University of Sydney, Sydney, NSW, Australia. .,Department of Plastic and Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
| |
Collapse
|
8
|
Leus AJG, Haisma MS, Terra JB, Diercks GFH, Van Kester MS, Halmos GB, Rácz E, Van Dijk BAC, Plaat BEC. Age-related Differences in Tumour Characteristics and Prognostic Factors for Disease Progression in Cutaneous Squamous Cell Carcinoma of the Head and Neck. Acta Derm Venereol 2022; 102:adv00652. [PMID: 34935990 PMCID: PMC9631266 DOI: 10.2340/actadv.v101.347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 11/16/2022] Open
Abstract
Guidelines for cutaneous squamous cell carcinoma of the head and neck do not take the age of the patient into account, but instead assume equal tumour characteristics and prognostic factors for poor outcome in younger and elderly patients. The aim of this study was to compare tumour characteristics of younger (< 75 years) and elderly (≥ 75 years) patients and identify age-specific risk factors for progression of disease, comprising local recurrence, nodal metastasis and distant metastasis. Patient and tumour characteristics were compared using χ2 or Fisher's exact tests. Multivariable competing risk analyses were performed to compare risk factors for progression of disease, incorporating the risk of dying before developing progression of disease. A total of 672 patients with primary cutaneous squamous cell carcinoma of the head and neck were retrospectively included. Larger tumour diameter, worse differentiation grade and deeper invasion were observed in older patients. In elderly patients, but not in younger patients, tumour diameter ≥ 40 mm, moderate differentiation grade and an invasion depth ≥ 2 mm were independent risk factors for progression of disease.
Collapse
Affiliation(s)
- Alet J G Leus
- Department of Dermatology, University Medical Center Groningen, Hanzeplein 1, NL-9700 RB Groningen. The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Lartizien R, Noyelles L, De Quatrebarbes J, Bettega G. Topographic superficial craniectomy for invasive scalp carcinoma. Int J Oral Maxillofac Surg 2021; 51:1007-1009. [PMID: 34656386 DOI: 10.1016/j.ijom.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/15/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
The management of non-melanoma skin cancer of the scalp that invades the deep structures can be challenging. An operative technique of topographic superficial craniectomy using a piezoelectric instrument (Piezosurgery (Mectron S.p.A., Carasco, Italy)) for tumours with periosteal invasion without diploic space invasion is presented here. The tumour was resected including the periosteum of the craniectomy area. A grid was carved through the outer table using the Piezosurgery device. The grid squares measured approximately 1.5 cm on each side. A bony strip was removed from one side of the grid to complete a deep cut while avoiding crossing the inner table. The squares were collected individually with a chisel and sent for pathological analysis. This technique was used to identify and localize any possible bone invasion. As this method allowed an accurate pathological diagnosis to be obtained from the Piezosurgery squares, it was possible to determine the appropriate adjuvant treatment, thereby reducing the risk of malignant cells spreading.
Collapse
Affiliation(s)
- R Lartizien
- Service de Chirurgie Maxillo-Faciale, Centre Hospitalier d'Annecy Genevois, Annecy, France.
| | - L Noyelles
- Service de Chirurgie Maxillo-Faciale, Centre Hospitalier d'Annecy Genevois, Annecy, France
| | - J De Quatrebarbes
- Service de Dermatologie, Centre Hospitalier d'Annecy Genevois, Annecy, France
| | - G Bettega
- Service de Chirurgie Maxillo-Faciale, Centre Hospitalier d'Annecy Genevois, Annecy, France
| |
Collapse
|
10
|
Kline NL, Bhatnagar K, Eisenman DJ, Taylor RJ. Survival outcomes of lateral skull base tumors following temporal bone resection. Head Neck 2021; 43:2414-2422. [PMID: 33851465 DOI: 10.1002/hed.26707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 03/05/2021] [Accepted: 04/01/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Lateral skull base tumors often necessitate temporal bone resection (TBR), although clinical outcomes can be unfavorable. Factors influencing survival and recurrence after TBR for cutaneous and salivary malignancies were evaluated. METHODS Twenty-six TBR subjects were included. Survival and recurrence outcomes were estimated at 1, 2, and 5 years postresection. Prognostic factors were analyzed using univariate and multivariate Cox regression. RESULTS Two years postresection, the overall survival (OS), disease-specific survival (DSS) and recurrence-free survival (RFS) rates were 61%, 74%, and 49%, respectively, and 51%, 63%, and 45% at 5 years. On univariate analysis, preoperative facial nerve dysfunction and intraoperative nerve sacrifice worsened OS, DSS, and RFS. Prior surgery and adjuvant radiation independently predicted reduced OS, DSS, and RFS on multivariate analysis. CONCLUSIONS Mortality is highest in the first 2 years following resection. Preoperative facial nerve dysfunction, facial nerve sacrifice, and prior radiation are negative predictors of survival and recurrence.
Collapse
Affiliation(s)
- Neila L Kline
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kavita Bhatnagar
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - David J Eisenman
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rodney J Taylor
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|