Use of Mohs Technique and Immediate Reconstruction for Advanced Head and Neck Cutaneous Squamous Cell Carcinoma

Abstract

Objectives: (1) Report the outcome of patients with cutaneous squamous cell carcinoma (SCCs) of the head and neck treated with Mohs micrographic surgery in the operating room. (2) Describe the method and benefits of a single operation for extirpation of cutaneous SCC and reconstruction in the operating room with the use of intraoperative Mohs margins. Methods: A total of 104 patients with cutaneous SCCs of the head and neck were retrospectively reviewed in a single-center retrospective study, considering recurrence, metastasis, and death between January 2002 and December 2008. The secondary aim was to describe the demographic and tumor characteristics, type of closure of defect, adjuvant therapies, immunocompromised status, bony or perineural invasion, and regional and local recurrence of SCC cases. Results: Twenty-one (20%) of the lesions were recurrent SCC. Ten (10%) patients had bony or perineural invasion. Additional extirpative procedures performed by the head and neck surgeons included 8 bone excisions (8%), 2 parotidectomies and neck dissections (2%). Eleven percent had local and 13% had regional recurrences. Nine percent of the total patient population died of disease. Disease-specific survival was 88%. Conclusions: Mohs micrographic surgery in the operating room for high-risk cutaneous SCC is effective. Using Mohs technique in the operating room permits a combined extirpation and reconstruction as a single procedure. This approach combines Mohs’ proven superior ability to produce clear margins with immediate reconstruction offered by the same surgeon. This offers patients many benefits, and extirpation with forethought of reconstruction offers potential superior outcomes, reduced hospitalizations and anesthetic exposures, and patient convenience.