Neck Nonmelanoma Skin Cancer Research Articles

Impact of the COVID-19 Pandemic on the Surgical Management of Head and Neck Non-Melanoma Skin Cancers in a Maxillofacial Center of Cluj-Napoca.

Background: The COVID-19 era has been a bleak period for both cancer and non-cancer patients, with delayed non-emergency treatments, such as for non-melanoma skin cancer (NMSC). This study aimed to evaluate how the treatment of NMSC patients was influenced by the management of the COVID-19 pandemic in an Eastern European Maxillofacial Surgery center. Materials and Methods: A total of 176 patients with a histopathological diagnosis of head and neck NMSC who were surgically treated in Cluj-Napoca Emergency County Hospital between 2016 and 2022 were included in this study, and divided into two samples, pre-pandemic (2016-2019) and COVID-19 (2020-2022) periods. Results: The pandemic presented with a decrease of 46.15% in patients' hospitalization, with wealthy and educated patients being prevalent. Even if the waiting time for surgery was increased, the stage of cancer and preference method for reconstruction did not differ. Despite the lower addressability of NMSC patients during the pandemic, there were no changes in surgical treatment. Conclusions: During COVID-19, the number of patients was reduced, with a longer waiting time for surgery, but without any changes in tumor stage and treatment preferences. However, the benefit of removing a cancer tumor is higher compared to the risk of developing COVID-19 infection during hospitalization.

Surgical Management of Patients with Parotid Involvement from Non-Melanoma Skin Cancer of the Head and Neck.

We conducted a retrospective, longitudinal study on a single-center series of patients who underwent parotidectomy in the management of advanced head and neck non-melanoma skin cancer (hnNMSC). The aim of this study was to identify prognostic factors associated with worse outcomes. Forty-one men and nine women were included. The mean age at the time of surgery was 78.9 years. The 5-year overall survival, disease-specific survival, locoregional recurrence-free survival, and distant metastasis-free survival calculated with Kaplan-Meier curves were 39.9%, 56.3%, 58.6%, and 82.1%, respectively. A univariate analysis showed that the status of the margins, facial nerve direct involvement, lymph vascular invasion, and histological grading were associated with worse outcomes (p < 0.05). Positive margins were associated with worse disease-specific survival also in a multivariate analysis (p = 0.001, HR = 32.02, and CIs 4.338 to 351.3). Because the resection in free margins is the most important prognostic factor, early diagnosis or, in the case of advanced disease, extensive surgical resection with concomitant reconstruction is needed. Adjuvant therapy is indicated in selected cases.

Surgery in the Era of Immunotherapy for Advanced Head and Neck Non-melanoma Skin Cancer.

Surgery remains the mainstay of treatment for non-melanoma skin cancer (NMSC). Immunotherapy (IO) has emerged as an alternative option. This review provides a contemporary summary of how to incorporate IO into the management of advanced NMSC. Evidence-based outcomes and recent clinical trials are provided with emphasis on the three most common NMSC diagnoses: cutaneous squamous cell carcinoma (cSCC), basal cell carcinoma (BCC), and merkel cell carcinoma (MCC). Surgical resection while preserving form and function remains the standard of care for the majority of NMSCs. In recalcitrant cases failing traditional surgery and/or primary radiation, patient ineligible for such treatments, or unresectable disease, IO has emerged as a promising alternative. In the majority of cases, it is a supplanting primary chemotherapy. Surgery remains the standard of care for NMSC. Immunotherapy has emerged as an alternative option for non-surgical candidates and as a neoadjuvant means to minimize morbidity.

The Role of miRNA-221 and miRNA-34a in Non-Melanoma Skin Cancer of the Head and Neck Region.

Non-melanoma skin cancer (NMSC) is one of the most frequent types of malignancy in the human body with an increasing incidence. Short, non-coding RNA molecules called microRNAs (miRNAs) can control post-transcriptional gene expression and they have a significant role in several physiological cellular processes and pathologies, including cancer. Depending on the functions of the genes, miRNAs may function as oncogenes or tumor suppressors. The aim of this paper was to describe the role of miRNA-34a and miRNA-221 in head and neck NMSC. Thirty-eight NMSC match paired (tumor and adjacent) tissue samples were evaluated by qRT-PCR. Total RNA was extracted and isolated from tissue samples using the phenol-chloroform (Trireagent) method according to the manufacturer's protocol. The concentration of RNA was measured by a NanoDrop-1000 spectrophotometer. The expression level of each miRNA was calculated by threshold cycle. For all statistical tests, the 0.05 significance level was used and two-tailed p values. All analyses were conducted in an R environment for statistical computing and graphics. We found the miRNA-221 being overexpressed in squamous cell carcinoma (SCC) (p < 0.05), basal cell carcinoma (BCC) and basosquamous cell carcinoma (BSC) compared with adjacent normal tissue. Additionally, the levels of miRNA-221 were two times higher (p < 0.05) in cases where the excision of the tumor was done with positive margins (R1), which means that we are the first to highlight the potential role of miRNA-221 in the microscopical local invasion. Mi-RNA-34a expression was altered in the malignant tissue compared with the adjacent normal one both in BCC and SCC but not statistically significantly. In conclusion, NMSC are challenging because of their increasing incidence and rapidly evolving development and discovering their molecular mechanisms of action lead us to understand tumorigenesis and evolution, while also contributing to the implementation of novel therapeutic keys.

71: Incidence and Management Trends in Locally Advanced Head and Neck Non-Melanoma Skin Cancer

71: Incidence and Management Trends in Locally Advanced Head and Neck Non-Melanoma Skin Cancer

When is a surgical multidisciplinary approach required in the management of head and neck non-melanoma skin cancer and in advanced head and neck pathologies involving skin?

SUMMARYNon-melanoma Skin cancer, including cutaneous squamous cell carcinoma and basal cell carcinoma, is the most common form of malignancy in the Caucasian population, and the skin of the head and neck is the site most involved. They should not be underestimated; in particular, high-risk lesions and advanced skin cancers require accurate diagnostic work up, aggressive surgical treatment and should be managed by the head and neck surgeon, the dermatologist and the plastic surgeon. Cutaneous head-neck malignancies are often overlooked or not routinely treated with a multidisciplinary surgical approach. Similarly, for primary head and neck cancers with involvement of surrounding skin, the involvement of the dermatologist and the plastic surgeon could better define an adequate diagnosis and treatment planning. The management of these patients presents both therapeutic and ethical problems, because the poor prognosis is burdened by facial disfigurement, open malodorous wounds and intractable pain. Therefore, in patients with advanced disease that is not candidate to radical surgery, palliative surgery with flap reconstruction could take place and could be proposed to improve quality of life.

The role of ultrasonography in head and neck Non-Melanoma Skin Cancer approach: an update with a review of the literature.

Non-Melanoma Skin Cancer is one of the most common cancer types and the face is the most affected region. The diagnosis of the skin cancer relies on clinical inspection, palpation, dermoscopy followed by incisional or excisional biopsy. When skin cancers are removed from the face, many factors are involved, including aesthetics. In addition, surgical planning with preoperative acknowledgement of the tumour margins is often the key to avoid incomplete excision, the need for reintervention, or in the prevention of functional and aesthetical defects in the treatment of skin tumours. In recent years, the development of new technologies in sonography, including high frequencies transducers can provide a full range of data. It can offer valuable information regarding the size of the tumour including the depth of invasion, the extent of the tumour, histology and subtypes of the lesions which are helpful for the treatment plan. It also may be efficient in detection of positive margins after surgery and it could play a role in the treatment of skin cancer, prevention of local recurrences and overall control of the disease. K.

MOHS micrographic surgery for head and neck nonmelanoma skin cancer: An approach for ENT surgeons.

Surgery is the main approach for skin cancer, with Mohs micrographic surgery (MMS) allowing the highest cure rates, best esthetics and superior functional outcomes. Ear, nose, and throat (ENT) surgeons are often challenged with patients presenting skin cancer, needing appropriate expertise to its adequate management. This paper highlights the most important aspects of MMS, enabling ENT surgeons to become familiar with its fundamental aspects. A review of the literature was performed, concomitantly presenting the author's outcomes as an ENT surgeon. A total of 51 MMSs were performed in 41 patients, and 78.4% of the tumors were cutaneous basal cell carcinomas (cBCCs), 19.6% were cutaneous squamous cell carcinomas (cSCCs), and one case was a microcystic adnexal carcinoma. Most tumors were located in high-risk areas (88.2%), and 84.3% of them were ≥10 mm in diameter. Most tumors (90.2%) required no more than two MMS excision steps to be completely removed. All cases were managed by reconstruction either using flaps or grafts. Recurrence occurred in only 2% of the cases. This study addressed the main issues of MMS, which may be important in ENT surgeons' daily practice.

Delayed Reconstruction with Full-Thickness Skin Grafts Following Defect Size Reduction in Head and Neck Nonmelanoma Skin Cancer.

Different treatment modalities have been applied for nonmelanoma skin cancers (NMSCs) of the head and neck area. One of the most important points after surgical treatment is the selection of appropriate reconstruction methods. The aim of this study is to investigate the efficacy and feasibility of the use of both defect size reduction with sutures and secondary healing with delayed reconstruction with full-thickness skin grafts in NMSC patients. In total, 18 (42.8%) male and 24 (57.2%) female patients with NMSC were operated. Defect size was measured both after excision and just before repair, and the approximate defect area was calculated with ImageJ software. Reconstruction was performed after 14 days in all patients in the second session, using free skin grafts. There were 18 (42.8%) male and 24 (57.2%) female patients. The mean age was 70.5 (45-82) years. The mean follow-up period was 40.3 (16-68) months. The mean defect area measured after excision was 8.44 ± 1.91 cm2. After 14 days of delay, the mean defect area was 5.51 ± 1.28 cm2 (34.8% reduction) (p < 0.05). Defect-reduction methods applied during the first session, together with proper interval prior to placement of graft, have been shown to be beneficial and acceptable methods, providing an advantage in reconstruction with free skin graft.

Long term response of electrochemotherapy with reduced dose of bleomycin in elderly patients with head and neck non-melanoma skin cancer

BackgroundElectrochemotherapy (ECT) is a local cancer treatment based on electroporation where the electric field is used to enhance cell membrane permeability and thereby facilitating the transition of chemotherapeutic agents into the cell. For the treatment of non-melanoma skin cancer, a standard dosage of 15,000 IU/m2 bleomycin (BLM) is used. The aim of the present study was to evaluate the long-term ECT response in the group of elderly patients with non-melanoma skin cancer treated with a reduced dose of BLM in comparison to the outcome in the patients treated with the standard dose of BLM.Patients and methodsTwenty-eight patients older than 65 years, with a total of 52 non-melanoma skin lesions were included in the study. Twelve patients (24 lesions) in the experimental group received a reduced dose of BLM (10,000 IU/m2), 16 patients (28 lesions) were treated with a standard dose of BLM (15,000 IU/m2).ResultsNo statistically significant difference in tumor control was observed between both groups. In the experimental group, tumors recurred in 39.0% of treated lesions in a median follow-up time of 28 months. In the control group, the recurrence rate of treated lesions was 15.4% in a median follow-up time of 40 months.ConclusionsECT with a reduced dose of BLM is a feasible treatment option for elderly patients with equal efficacy to standard dose treatment and should be considered as a treatment modality in advanced aged patients with comorbidities, where overall life expectancy is poor.

PO-176 Management of head and neck non-melanoma skin cancer in the elderly

PO-176 Management of head and neck non-melanoma skin cancer in the elderly

Nonmelanoma skin cancer of the head and neck region in solid organ transplant recipients.

Nonmelanoma skin cancers (NMSC) are the most common malignancies in solid organ recipients. We investigated the incidence, clinical features, and outcome of solid organ recipients with NMSC of the head and neck. A retrospective chart review was conducted for solid organ recipients who were treated from 1992 to 2015 and who developed NMSC of the head and neck. Of 3339 organ recipients, 259 patients developed 697 head and neck NMSC. Squamous cell carcinoma was the most common malignancy (55%). The overall 5-year and 10-year survival was 68% and 45%. Kidney recipients had better survival outcome than other organ recipients (10 vs 7 years). Advanced-stage cancers (10%), aggressive patterns of tumors (21%), and treatment with Prograf and Cellcept were associated with increased disease-specific mortality. Solid organ transplant increases the risk of NMSC of the head and neck. Aggressive tumors decrease patient survival and warrant more decisive and multidisciplinary approach.

Management of the Neck for Non-melanoma Skin Cancer

To summarize the current management of the neck lymph node basin for head and neck non-melanoma skin cancers. Over the last 5 years, there have been updates to staging for cSCC and MCC. T classification of the AJCC staging system has been changed to match the UICC staging system. MCC staging has been updated based on data from the National Cancer Data Base. Sentinel lymph node biopsy, while established in MCC, is playing a growing role in the management of high-risk N0 cSCC. The optimal management of N0 neck varies by metastatic potential. In low-risk malignancy, no workup is necessary. In cSCC, risk stratification is necessary. High-risk tumors with N0 necks should undergo preoperative imaging with CT and targeted FNA of suspicious lymph nodes. If radiologically negative, a SLNB should be considered. Selective neck dissection should be performed for N+ disease and positive SLNB. Elective neck dissection is not routinely recommended and should be reserved for positive parotid nodal disease. Merkel cell carcinoma has high rates of nodal metastases and requires preoperative imaging with targeted FNA of suspected metastases. SLNB should be performed for N0 disease to guide prognostication and further treatment. Management of negative SLN is controversial, and most can be observed while radiation may be considered for high-risk patients. Positive SLN requires completion neck dissection and radiation.

Radiotherapy regimens in patients with nonmelanoma head and neck skin cancers.

To assess the effectiveness and outcomes of adjuvant radiotherapy regimens for nonmelanoma skin cancers (NMSC) of the head and neck, particularly for elderly patients. A retrospective review of patients with head and neck NMSC was conducted. Radiotherapy dose per fraction regimens included ≤200, 240-250, 300-400, and 500-600 cGy. Demographics, tumor characteristics, local control (LC), regional control (RC), and survival outcomes were analyzed. Of the 90 patients with 140 disease sites, 76.6% were squamous cell carcinoma, 15.5% were basal cell carcinoma, and 7.7% were other histologies. The mean age at diagnosis was 72.1 years old. The most common location was preauricular (20.0%), followed by temple, scalp, cheek, and forehead. The overall LC and RC rates were 88.8% and 88.8%, respectively by patients, and 92.8% and 86.4%, respectively by treatment sites. Age, primary tumor location, T classification, N classification, overall stage, perineural invasion, comorbid disease, skull base invasion, and radiotherapy subgroup were significantly associated with disease-free and overall survival (P < 0.05). LC and RC were not significantly different among the radiotherapy dose subgroups. The mean survival was longer in patients treated with 240-250 cGy/fraction (50.3 months). There was no significant difference in radiotherapy toxicity between the subgroups. Short-term radiotherapy regimens for patients with locally or regionally advanced head and neck NMSC appear feasible and effective, particularly in elderly patients or those that cannot tolerate the length of standard regimens.

Skull Base Invasion Patterns and Survival Outcomes of Nonmelanoma Skin Cancers.

Objective Report routes of skull base invasion for head and neck nonmelanoma skin cancers (NMSCs) and their survival outcomes. Design Retrospective. Participants Ninety patients with NMSC with skull base invasion between 2004 and 2014. Major Outcome Measures Demographic, tumor characteristics, and treatments associated with different types of skull base invasion and disease-specific survival (DSS) and overall survival (OS). Results Perineural invasion (PNI) to the skull base occurred in 69% of patients, whereas 38% had direct skull base invasion. Age, histology, orbital invasion, active immunosuppression, cranial nerve (CN) involved, and type of skull base invasion were significantly associated with DSS and OS (p < 0.05). Patients with basal cell carcinoma (BCC) had significantly improved DSS and OS compared with other histologies (p < 0.05). Patients with CN V PNI had significantly improved DSS and OS compared with CN VII PNI (p < 0.05). Patients with zone II PNI had significantly improved DSS and OS compared with those with direct invasion or zone III PNI (p < 0.05). Nonsurgical therapy was rarely used and is associated with a reduction in DSS and OS (p < 0.05). Conclusion Patterns and survival outcomes for NMSC skull base invasion are reported. Zone II PNI, BCC, and CN V PNI are associated with improved survival outcomes.

Head and neck nonmelanoma cutaneous malignancy treatment in a skin cancer referral center

The purpose of our study was to determine the level of accuracy provided by clinical diagnosis in head and neck cutaneous malignancy as confirmed by histopathologic examination of the specimen in a skin cancer referral center. Positive predictive value was selected as a reliable measure of diagnostic accuracy. We also aimed to audit our surgical outcomes and record and present the completeness of excision, the rates of recurrence and metastasis, and the reconstructive method. We reviewed the electronic charts of 867 consecutive patients with skin tumors and calculated the positive and negative predictive values of clinical diagnosis. The positive predictive value was 91% for basal cell carcinoma and 78.8% for squamous cell carcinoma. Of the 178 histologically diagnosed squamous cell carcinomas, 15 were metastatic. In a skin cancer referral center, expert clinical diagnosis may safely overcome the need for preoperative biopsy. Relying on clinical diagnosis to formalize a treatment plan for head and neck nonmelanoma skin cancer is safe and efficient. This is more reliable in cases of basal cell carcinoma compared with suspected squamous cell carcinomas.

Head and Neck Non-Melanoma Skin Cancer Treated By Superficial X-Ray Therapy: An Analysis of 1021 Cases

IntroductionTo report a single-institutional experience with the use of Superficial X-Ray Therapy (SXRT) for head and neck non-melanoma skin cancer (N-MSC) and to compare outcomes by prescribed fractionation schedules.Materials and MethodsThe medical records of 597 patients with 1021 lesions (720 BCC, 242 SCC, 59 SCC in situ) treated with kilovoltage radiation from 1979–2013 were retrospectively reviewed. The majority of patients were treated according to 1 of 3 institutional protocols based on the discretion of the radiation oncologist: 1) 22 x 2.5 Gy; 2) 20 x 2.5 Gy; 3) 30 x 2.0 Gy. "T" stage at first presentation was as follows: Tis (59); T1 (765); T2 (175); T3 (6), T4 (9); Tx, (7). All patients were clinical N0 and M0 at presentation. Chi-square test was used to evaluate any potential association between variables. The Kaplan-Meier method was used to analyze survival with the Log Rank test used for comparison. A Cox Regression analysis was performed for multivariate analysis.ResultsThe median follow up was 44 months. No significant difference was observed among the 3 prescribed fractionation schemes (p = 0.78) in terms of RTOG toxicity. There were no failures among SCC in situ, 37 local failures (23 BCC, 14 SCC), 5 regional failures (all SCC) and 2 distant failures (both SCC). For BCC, the 5-year LC was 96% and the 10-year LC was 94%. For SCC the corresponding rates of local control were 92% and 87%, respectively (p = 0.03). The use of >2.0 Gy daily was significantly associated with improved LC on multivariate analysis (HR: 0.17; CI 95%: 0.05–0.59).ConclusionSXRT for N-MSC of the head and neck is well tolerated, achieves excellent local control, and should continue to be recommended in the management of this disease. Fractionation schedules using >2.0 Gy daily appear to be associated with improved LC.

False-negative rate of intraoperative frozen section margin analysis for complex head and neck nonmelanoma skin cancer excisions.

Intraoperative frozen section analysis (IFSA) is traditionally performed for complex and high-risk non-melanoma skin cancer (NMSC) resections, particularly when surgery under a general anaesthetic and a complex reconstruction is required, and where Mohs micrographic surgery (MMS) is not available. A retrospective audit of 253 cases between 1999 and 2009 was undertaken, investigating the accuracy and efficacy of IFSA for the treatment of NMSC in our tertiary skin tumour unit based in a university hospital setting. The combined incomplete and very narrow (<1 mm) excision margin rates were 28.7% and 27.5% for basal cell and squamous cell carcinoma, respectively. Unrepresentative sampling of the excision margins intraoperatively was the overwhelming cause of error (94%). After a thorough audit of our data, IFSA has been abandoned for the treatment of NMSC in our unit. MMS is practised intraoperatively, even in advanced cases. We believe that IFSA no longer has any role in our complex, multidisciplinary skin cancer practice.

Positive predictive value of clinical diagnosis of head and neck non-melanoma skin malignancies. How accurate are we?

ᅟ: The purpose of the current study was to determine the accuracy of the clinical diagnosis in non-melanoma skin malignancy as confirmed by histopathological examination of the specimen. Positive predictive value (PPV) was selected as a reliable measure of diagnostic accuracy. Clinical diagnosis was made in the outpatient clinic by a consultant oral and maxillofacial surgeon. We reviewed the electronic charts of 210 patients with non-melanoma skin malignant tumours and calculated the positive predictive value of the initial clinical diagnosis. Histological confirmation for each lesion was compared with the provisional clinical diagnosis made in the clinic. Of the 147 lesions provisionally diagnosed as basal cell carcinomas, 133 lesions were histologically confirmed to be basal cell carcinomas (BCC) (PPV 90.4%). Of the 63 lesions provisionally thought to be squamous cell carcinomas, 47 lesions were histologically confirmed as squamous cell carcinomas (SCC) (PPV 74.6%). The difference between the PPVs for the two types of malignancy in our study was not significant (p = 0.39). Statistics between our results for BCC and SCC and those reported from two other cancer institutes revealed no significant difference (p = 0.58 and 0.07). The present study supports that relying on clinical diagnosis with the purpose to formalise a treatment plan for head and neck non-melanoma skin cancer is safe and efficient. This is more reliable in cases of basal cell carcinoma in comparison to suspected squamous cell carcinomas. Although positive predictive value represents a reliable measure of diagnostic accuracy, it is increased when populations with higher prevalence of the disease are studied.

Head and Neck Non-Melanoma Skin Cancer: Adherence to core data reporting

Introduction/Aims: In 2012 the Royal College of Pathologists (RCPath) published the required datasets for the histological reporting of primary cutaneous basal and squamous cell carcinomas with a recommendation for regular audit and 90% compliance for reporting of core data. Poster presentations for BAOMS Annual Scientific Meeting 2-4 July 2014, Edinburgh International Conference Centre, ScotlandBritish Journal of Oral and Maxillofacial SurgeryVol. 52Issue 8Preview Full-Text PDF