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Craniofacial Resection for Nonmelanoma Skin Cancer of the Head and Neck
Author(s) -
Backous Douglas D.,
DeMonte Franco,
ElNaggar Adel,
Wolf Pat,
Weber Randal S.
Publication year - 2005
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1097/01.mlg.0000163766.66223.97
Subject(s) - medicine , craniofacial , skin cancer , perineural invasion , surgery , radiation therapy , retrospective cohort study , craniofacial surgery , perioperative , basal cell carcinoma , head and neck cancer , cancer , basal cell , psychiatry
Objectives/Hypothesis: We reviewed our experience with craniofacial resection for advanced, nonmelanoma skin cancer of the head and neck to determine prognostic factors, local control rate, disease free survival, morbidity, and mortality. Study Design: Retrospective review of consecutive patients treated at a tertiary referral center from 1982 to 1993. Methods: Charts of patients having craniofacial resection for aggressive nonmelanoma cutaneous malignancies were reviewed and living patients followed for 10 additional years. Demographics, histology, previous interventions, treatment, surgical pathology, reconstructions, and complications were examined. The product‐limit method was used to calculate survival functions, and the log‐rank test was used to compare survival distributions. Results: Thirty‐five patients, mean age 66.7 years, received treatment at our facility. Follow‐up ranged from 2 to 191 (mean 47.4) months. Histology included 20 squamous cell carcinomas (SCC) and 15 basal cell carcinomas (BCC). Sixty percent had craniofacial resection alone, and 28.6% also had postoperative radiotherapy. There were two perioperative deaths, and 37.1% suffered early and 14.3% late surgical complications. Two‐ and five‐ year survival was significantly better ( P = .02) with BCC (92% and 76%) than with SCC (54% and 24%). Long‐term disease‐specific survival was 20%, and 11.4% of our subjects were living with disease. Intracranial extension ( P = .02), perineural invasion ( P = .049), and prior radiotherapy significantly decreased 5‐year survival. Conclusions: Acceptable mortality and morbidity is possible using craniofacial resection to treat advanced nonmelanoma skin cancer. Although disease‐specific survival remains poor, positive trends were noted in local control beginning at 2 years of follow‐up. Because patients often have few remaining options for cure, craniofacial resection is justified when technically feasible.