Excision Of Squamous Cell Carcinoma Research Articles

Challenges in Radial Forearm Free Flap Surgery: A Comprehensive Case Analysis of Septic Complications at the Donor Site.

The radial forearm free flap (RFFF) has emerged as a leading option for microvascular reconstruction of head and neck soft-tissue defects. Despite the favorable outcomes conferred by RFFFs, complications such as skin graft loss and tendon exposure can occur. We present the case of a 77-year-old man who underwent RFFF reconstruction after excision of squamous cell carcinoma from the head and neck. The patient subsequently developed flexor tenosynovitis, septic arthritis of the wrist, and osteomyelitis of several carpal bones as a direct result of partial skin graft loss and prolonged tendon exposure at the donor site. To the best of our knowledge, this is the first reported case of this specific complication. Review of the literature reveals the need for continued research into RFFF donor site complications to mitigate the incidence of significant morbidity.

The Free Flap Reconstruction of Facial Defects after Squamous Cell Carcinoma Excision.

Background and Objectives: Cutaneous squamous cell carcinoma is the second most common skin cancer. There are many methods for the reconstruction of facial subunit defects after skin cancer excision. The face is vital to a person's life and should be reconstructed considering functional and aesthetic aspects. Despite a variety of flap types and techniques, it is still challenging to meet the various demands. The aim of this study was to compare free flaps for facial reconstruction after resection of cutaneous squamous cell carcinoma. Materials and Methods: This study included 14 patients from January 2021 to June 2023. Patients who underwent facial SCC resection and subsequent reconstruction using free flaps were analyzed retrospectively. Age, sex, and localization were recorded. Follow-ups ranged from 5 to 21 months, with an average of 13 months. Results: All free flaps survived well except one case of partial flap necrosis. In most patients, good to excellent functional and aesthetic results were obtained. The donor site healed uneventfully in all patients. Conclusions: Free flap reconstruction is an excellent choice in wide skin oncologic defects. In terms of texture, it also could be a good surgical method. The use of a fraxel laser can progressively facilitate improved color matching with the surrounding skin.

Prospective Randomized Study on the Use of Sentinel Node Biopsy for High-risk Cutaneous Squamous Cell Carcinomas of the Head and Neck.

The use of sentinel lymph node biopsy (SLNB) for high-risk cutaneous squamous cell carcinoma (CSCC) is not yet clearly documented, especially for the head and neck area, due to its rich and cross-branching lymphatic system. We present the first prospective randomized study on the use of SLNB in high-risk CSCCs of the head and neck. Seventy-six patients with high-risk CSCCs of the head and neck were randomly divided into two groups: A (n = 38) and B (n = 38). In group A, SLNB was performed additionally to the excision of squamous cell carcinoma, whereas in group B, only excision of the lesion was performed. The patients were followed up for 5 years postoperatively, and local recurrences, regional metastases (regional lymph nodes), and mortality were documented. One patient of group A, who never attended any follow-up, was excluded. Both groups had similar characteristics regarding Breslow thickness, perineurial invasion, peripheral limits, differentiation, size, previous incomplete excision, age, sex, education, sun exposure, Fitzpatrick score, previous incomplete excision, previous skin cancer, and smoking. Two patients had a positive sentinel lymph node and were submitted to regional lymphadenectomy. We documented deaths (three in group A and two in group B; P = 0.674), local recurrence (seven in group A and six in group B; P = 0.768), and regional metastasis (zero in group A and two in group B; P = 0.159). There is no clear benefit on the use of SLNB in high-risk CSCCs of the head and neck regarding metastasis, mortality, or local recurrence control.

Large facial malignant tumor defect reconstruction using keystone flap: a case report

Background: Facial defects resulting from a large malignant tumor excision are often too extensive for primary closure, necessitating the use of skin flaps or grafts. The challenge is particularly pronounced when the defects occur in the facial region. Deciding how to reconstruct facial defects involves considering various factors, with aesthetics taking precedence over other body parts. The preferred method for closing these defects is ideally by transposing local tissues with similar qualities, especially in cases where primary closure is not feasible due to the size of the defect. Case presentation: A case report study of a 60-years-old female patient referred to H. Adam Malik Hospital and underwent excision of malignant tumor and left with large defect on the right cheek and 2/3 upper & 1/3 lower vermillion. Skin flap techniques, such as the advancement flap, rotation flap, and transposition flap, are useful for closing small defects. When dealing with moderate to large-sized defects, especially in high-tension areas, a combination of flap types may be necessary. Over the past two decades, pedicled perforator flaps, notably the keystone flap design, have gained popularity as a viable option. Understanding facial aesthetic units, subunits, and factors influencing incision/scar placement is crucial for clinicians aiming to achieve the most cosmetically pleasing outcome. Conclusions: The presented case details the successful closure of a sizable cheek defect post squamous cell carcinoma excision surgery, achieved through the utilization of a KPIF Type IIA. Patient showed good flap survival.

Appropriate Surgical Margins for Excision of Squamous Cell Carcinoma of the Lower Lip.

Background Squamous cell carcinoma (SCC) is the most common malignancy on the lower lip. Surgical excision, the standard treatment for SCC, requires full-thickness excision. However, no consensus exists about the appropriate surgical margin. Therefore, we investigated the appropriate surgical margin and excision technique by analyzing 23 years of surgical experience with lower-lip SCC. Methods We reviewed 44 patients with lower-lip SCC who underwent surgery from November 1997 to October 2020. Frozen biopsy was performed with an appropriate margin on the left and right sides of the lesion, and the margin below the lesion was the skin above the sulcus boundary. If the frozen biopsy result was positive, an additional session was performed to secure a negative margin. Full-thickness excision was performed until the final negative margin. In each patient, the total number of sessions performed, final surgical margin, and recurrence were analyzed. Results Forty-one cases ended in the first session, 2 ended in the second session, and 1 ended in the third session. The final surgical margins (left and right; n = 88) were 5 mm (66%), 7 mm (9%), 8 mm (2.3%), 10 mm (20.4%), and 15 mm (2.3%). During an average follow-up of 67.4 months (range, 12-227 months), recurrence occurred in one patient. Conclusion The final surgical margin was 5 mm in 66% (58/88) of the cases, and 97.7% (86/88) were within 10 mm. Therefore, we set the first frozen biopsy margin to 5 mm, and we suggest that a 5-mm additional excision is appropriate when frozen biopsy results are positive.

New-onset lichenoid dermatitis following excision of squamous cell carcinoma: Coincidence or association?

New-onset lichenoid dermatitis following excision of squamous cell carcinoma: Coincidence or association?

Patient-dependent risk factors for wound infection after skin surgery: A systematic review and meta-analysis.

Postoperative wound infection in dermatologic surgery causes impaired wound healing, poor cosmetic outcome and increased morbidity. Patients with a high-risk profile may benefit from perioperative antibiotic prophylaxis. The objective of this systematic review was to identify risk factors for surgical site infection after dermatologic surgery. In this article, we report findings on patient-dependent risk factors. The literature search included MEDLINE, EMBASE, CENTRAL and trial registers. We performed meta-analysis, if studies reported sufficient data to calculate risk ratios with 95% confidence intervals. Study quality was assessed according to the Newcastle-Ottawa-Scale. Seventeen observational studies that analysed 31213 surgical wounds were eligible for inclusion. Fourteen studies qualified for meta-analysis. Nine studies showed good, three fair and five poor methodological quality. The reported incidence of surgical site infection ranged from 0.96% to 8.70%. Meta-analysis yielded that male gender and immunosuppression were significantly associated with higher infection rates. There was a tendency towards a higher infection risk for patients with diabetes, without statistical significance. Meta-analysis did not show different infection rates after excision of squamous cell carcinoma or basal cell carcinoma, but studies were substantially heterogenous. There was no significant association between risk for wound infection and smoking, age over 60 years, oral anti-aggregation or anti-coagulation or excision of malignant melanoma. In conclusion, the risk for surgical site infection in dermatologic surgery is low. Infection rates were increased significantly in male as well as immunosuppressed patients and non-significantly in diabetics.

Reconstruction of a large nasal defect using a folded forehead flap: a case report

Forehead flaps are widely used to reconstruct nasal defects. The authors report a case wherein a folded forehead flap was used to reconstruct a large nasal defect after wide excision of squamous cell carcinoma. A 65-year-old man was diagnosed with squamous cell carcinoma by a punch biopsy conducted at the dermatology department, and the mass was located in the left nasal vestibule. A forehead flap was planned to cover the full-thickness defect that occurred after wide excision. A flap with an extended transverse skin paddle was designed; thereafter, the distant part of the flap was folded up to the nasal lining inside the nose. The interpolation flap was properly maintained for 3 weeks, and flap division was performed. The reconstructed nose exhibited symmetry during a 5-month observation period. A folded forehead flap is a surgical option when considerable nasal restoration, including soft tissue and the internal lining, is necessary.

Application of Mohs Technique for Squamous Cell Carcinoma of the Nipple

Cutaneous squamous cell carcinoma (SCC) of the nipple areolar complex (NAC) is a rare entity with only a few cases reported in the medical literature. The standard treatment for invasive squamous cell carcinoma includes complete surgical excision of the lesion with postoperative assessment of free margins. Although this skin cancer involves the NAC it should be considered as a completely separate entity from other breast cancers, and therefore may be treated differently than breast cancers involving the NAC. Mohs micrographic surgery is a well-accepted technique for non-melanoma skin cancers (NMSC) with its remarkable precision for tumor eradication and tissue-sparing properties which favor excellent aesthetic outcome. We present a clinical case of 75-year-old Caucasian female who presented to our clinic with a papulose, scaly lesion located at her right nipple that was confirmed to be SCC of the nipple. The patient underwent complete excision of the tumor using Mohs micrographic technique with immediate reconstruction of spared NAC using purse-string suture technique. Free surgical margins were determined intra-operatively by Mohs’s cryosurgery method and further assessed by permanent evaluation. Follow-up was assessed for 3 years without evidence of local recurrence, and high patient satisfaction with the final aesthetic outcome. To the best of our knowledge, this is the first report that validates the feasibility of application of the Mohs technique for nipple SCC excision with immediate nipple reconstruction. Our results suggest that Mohs micrographic surgical technique may be a safe treatment modality for SCC lesions of the NAC allowing superior tissue preservation and enhanced aesthetic results compared to standard wide local excision.

A Case of Squamous Cell Carcinoma Due to Neglected AV Fistula for Dialysis

Squamous cell carcinoma is a malignancy arising from keratinocytes. Arteriovenous (AV) fistula is one of the rare conditions causing chronic inflammation of skin and underlying structure. AV fistula can create catastrophic complications such as squamous cell carcinoma if neglected. There are very few reports of squamous cell carcinoma due to Av fistula. Most of the cases require surgical excision of squamous cell carcinoma with ligation of AV access if infiltrated. Early detection of cutaneous malignancy will reduce the morbidity and mortality related to malignancy and it also salvages the AV fistula.

A study of the effects of delayed patient presentation on cutaneous SCC progression

A cohort study of patients, who underwent cutaneous squamous cell carcinoma (SCC) excision, was undertaken to evaluate the effects of the COVID-19 pandemic on treatment times and histopathological features. We identified all patients who had SCCs excised in October 2020 (pandemic group); the control group included all patients who underwent excision of SCCs during October 2019 (pre-pandemic group). Collected data included SCC subtype, thickness, size, clearance margins, referral details, patient comorbidities and operative data. There were 140 patients (174 SCCs; pre-pandemic group=74; pandemic group=100) identified for study inclusion. Both groups were well matched for age, sex, previous history of cancer, cutaneous SCC and histological subtype. There was a delay in median patient presentation time to the GP in the pandemic versus pre-pandemic group (106 days vs. 56 days, p <0.001); this led to a longer overall time to surgery (167 days vs. 110.5 days, p<0.001). Pandemic group SCCs had larger median Breslow depths (4mm vs. 3mm, p=0.01), a greater proportion of Clark's level 4 and 5 lesions (76.9% vs. 61.1%, p=0.03), and a higher rate of high (20-40mm) and very high (>40mm) risk SCCs as defined by British Association of Dermatology diameter criteria (56.1% vs. 39.2%, p=0.03), versus the pre-pandemic group. There was a 57-day median SCC treatment delay, and an associated development of higher risk SCCs by the time of surgery. Despite the challenges of a pandemic, patients should seek early consultation for suspicious skin changes, and healthcare systems should maintain skin cancer treatment pathways.

Sorafenib-related generalized eruptive keratoacanthomas (Grzybowski syndrome): a\xa0case report

BackgroundSorafenib is an oral multikinase inhibitor that targets Raf serine/threonine receptor tyrosine kinases and inhibits tumor cell growth and angiogenesis. Cutaneous toxicities of sorafenib are common, including cutaneous eruptions (such as truncal erythema and seborrheic-dermatitis-like changes) and hand–foot syndrome. Keratoacanthomas and squamous cell carcinomas have been reported previously; however, we report a case of multiple eruptive keratoacanthomas in the form of Grzybowski syndrome after initiation of sorafenib.Case presentationWe report a 63-year-old Caucasian male who developed multiple cutaneous eruptive keratoacanthomas after starting sorafenib 400 mg twice daily. He had a known history of hepatitis-C-related cirrhosis and hepatocellular carcinoma, and previously had actinic keratosis and skin squamous cell carcinoma excision. Approximately two and a half months after starting sorafenib, the patient initially developed two lesions, one on each forearm, and after excision, these lesions demonstrated histological features of squamous cell carcinoma. One month later, the patient presented with approximately 48 new skin lesions of varying size on the back, bilateral upper limbs, and face requiring excisional biopsy of a large number of these lesions. Histopathology showed eruptive invasive keratoacanthomas (Grzybowski syndrome). Sorafenib was temporarily stopped and subsequently restarted at a lower dose. Acitretin 25 mg daily was commenced after few weeks, and no further keratoacanthomas developed during his treatment.ConclusionsWe report a unique case of sorafenib-associated Grzybowski syndrome. Temporary interruption and dose reduction of sorafenib and use of acitretin appeared to prevent further development of keratoacanthomas.

Extended, Double-Pedicled Facial Artery Musculomucosal (dpFAMM) Flap in Tongue Reconstruction in Edentulous Patients: Preliminary Report and Flap Design.

Backgroundand Objectives: The reconstruction of tongue defects after cancer resection is challenging for reconstructive surgeons. The facial artery musculomucosal (FAMM) flap and the myomucosal buccinator flap (Bozola flap) are important tools in the reconstruction of intraoral defects. In this study, we describe the combination of both flaps—the extended, double-pedicled FAMM (dpFAMM) flap—and present clinical results of the reconstruction of moderate tongue defects in edentulous patients. Materials and Methods: a tongue defect, after squamous cell carcinoma excision, was reconstructed with the dpFAMM flap in 5 patients. Most of them received postoperative radiotherapy. Results: the healing process was uneventful in all patients. We did not observe flap necrosis or venous congestion. Tongue mobility, speech and swallowing were satisfactory. Conclusions: In conclusion, the dpFAMM flap is a good alternative in the reconstruction of moderate defects of the lateral part of the tongue. The flap is easy to harvest and has a good vascularity. This is a predictable method of reconstruction, especially for elderly patients with numerous comorbidities.

Intralesional 5-fluorouracil for the treatment of squamous cell carcinomas

To the Editor: The standard treatment for squamous cell carcinomas (SCCs) is wide local excision or Mohs micrographic surgery. Excision of SCCs in difficult areas, such as the lower extremity, can be challenging and associated with increased complications.1 Intralesional 5-fluorouracil (IL5-FU) is a minimally invasive therapeutic option that may benefit select patients for whom surgical excision is not desired or feasible. Most studies to date have been limited to small studies, case series, and recent case reports.

Scalp Reconstruction With Three Rhomboid Flaps After Squamous Cell Carcinoma Excision

Scalp Reconstruction With Three Rhomboid Flaps After Squamous Cell Carcinoma Excision

Early nasal reconstruction after skin-preserving excision of squamous cell carcinoma of the nasal vestibule

Surgery for early-stage squamous cell carcinoma of the nasal vestibule (SCCNV) may lead to facial disfigurement. We wanted to investigate if skin-preserving excision of SCCNV with reconstruction is oncologically, aesthetically, and functionally justifiable in cases with proximity to the skin. From 2010 to 2016, 16 patients underwent skin-preserving excision of T1-2 N0 SCCNV by a lateral rhinotomy approach at a tertiary referral center. The inner nose was reconstructed using a mucoperichondrial septal flap for the inner lining and a septal pivot flap and/or auricular cartilage grafting for the framework. Nasal appearance was measured on pre- and postoperative photographs. Median follow-up was 5.4 years. Three (19%) patients received adjuvant radiotherapy. Two (12.5%) recurrences occurred locally, but not at the site of preserved skin. The Kaplan-Meier estimate of local control rate after 5 years was 83%. All patients could be salvaged, giving an ultimate control rate of 100%. Nasal tip projection decreased by 6.7% (p<0.001), and it was retained normal or near normal in 87.5% of patients. Nasal axis changed by 1.7° (p = 0.5). Nasal deviation occurred in 6.25% (1/16) of patients, and minor alar retraction in 6.25% of patients (1/16). Nasal breathing was normal or close to normal in 75% (12/16) of patients. Skin-preserving excision of SCCNV is oncologically justifiable in selected cases even in proximity to nasal skin. Early inner nasal reconstruction preserves nasal form and function to a high degree. This technique is a suitable alternative to rhinectomy and to avoid the sequelae of radiotherapy in selected cases.

Efficacy and safety of 5-aminolevulinic acid photodynamic therapy for the treatment of ulcerative squamous cell carcinoma.

Photodynamic therapy is a nonsurgical alternative to conventional tumor excision for squamous cell carcinoma. In addition, photodynamic therapy has many advantages in improving wound healing, especially for diabetic foot lesions and infected ulcers. However, the effect of photodynamic therapy on ulcerative squamous cell carcinoma is not yet clear. In this study, we aimed to evaluate the effectiveness of photodynamic therapy in treating squamous cell carcinoma. A total of six cases of ulcerative squamous cell carcinoma were included in our study. Each ulcer region was irradiated with 120 J/cm2 using a 635-nm red light-emitting diode after application of 5-aminolevulinic acid solution at 1-week intervals. The number of treatment sessions depended on the healing of the lesions. The ulcerative lesions showed complete clinical remission with an average 3.7 photodynamic therapy sessions. There was no recurrence during a follow-up of 8.5 months (range, 3 months to 1 year). The patients were able to complete the treatment protocol with good cosmetic results and no significant complications. In addition, most patients reported significant improvement in their quality of life. Photodynamic therapy is a promising method for treating ulcerative squamous cell carcinoma. However, its effects need to be validated in larger patient samples in clinical trials.

Ultrasound aids in intraoperative assessment of deep resection margins of squamous cell carcinoma of the tongue.

We wanted to find out whether ultrasound (US) can be used to assess the deep resection margins after excision of squamous cell carcinoma (SCC) of the tongue, as intraoperative feedback on their condition might help to prevent them being too close. Resected specimens of cancers of the tongue from 31 patients with SCC of the tongue were suspended in US gel and scanned with a small 5-10MHz US probe. The tumour was readily visible and US could differentiate it from muscle tissue. The margin of normal tongue musculature surrounding the tumour was measured on the US images, and the minimal resection margin was noted and compared with that reported by the histopathologist. The mean (SD) deep resection margins measured on the US images differed by 1.1 (0.9) mm from those reported by the histopathologist (Pearson's correlation coefficient: 0.79, p<0.01). The US measurements took a maximum of five minutes. It is feasible to use US to assess resection specimens of SCC of the tongue as an adjunct to existing strategies (such as frozen section analysis) to help achieve the desired deep surgical margins. The method is easy to incorporate into surgical routine as it does not take long.

Clinicopathological Factors Associated with Incomplete Excision of Cutaneous Squamous Cell Carcinoma.

Cutaneous squamous cell carcinoma (SCC) is the second most common type of cancer in Swedish men and women. The incidence of SCC is increasing rapidly. Primary treatment is complete surgical excision with sufficient margins to avoid recurrence and metastasis. The aim of this retrospective study was to identify the clinicopathological factors associated with incomplete excision of SCCs. Clinicopathological data and surgical outcome was obtained for 691 SCCs excised during a 2-year period (2014 to 2015) in Gothenburg, Sweden. Overall, 81 SCCs (11.7%) were incompletely excised. Incomplete excisions were associated with physician specialty and experience, tumour localization in the head and neck region, larger tumour diameter, and lower grade of tumour differentiation. However, multiple regression analysis revealed that large tumour size and excisions carried out by general practitioners were the only factors that significantly negatively affected rates of incomplete excision. These results should be taken into consideration when excising SCCs, in order to avoid multiple excisions.

Squamous Cell Carcinoma excision and upper lip reconstruction with double advancement technique

Squamous Cell Carcinoma excision and upper lip reconstruction with double advancement technique