Craniofacial Resection for Nonmelanoma Skin Cancer of the Head and Neck

Backous, Douglas D.; DeMonte, Franco; El‐Naggar, Adel K.; Wolf, Pat; Weber, Randal S.

doi:10.1097/01.mlg.0000163766.66223.97

Cited by 29 publications

(27 citation statements)

References 16 publications

(43 reference statements)

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“…Furthermore, published literature to date does not specifically focus on NMSCs with intracranial extension. 1,9 Hence, the role of surgery and the extent to which it should be pursued in light of intracranial and/or cranial nerve invasion is unclear due to the relative lack of evidence on this subject. We currently pursue resection in patients who meet the following criteria: lack of major medial comorbidities, high performance status, lack of major vessel (arterial or venous) involvement, absence of lower cranial nerve involvement, lack of extensive or eloquent brain invasion, and presence of only local disease at presentation.…”

Section: Discussionmentioning

confidence: 99%

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Nonmelanoma cutaneous cancers involving the skull base: outcomes of aggressive multimodal management

Raza¹,

Ramakrishna²,

Weber

et al. 2015

JNS

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R epResenting the most common human neoplasm, skin cancers occur in the head and neck region in nearly 90% of cases due to sun exposure. Of these, nonmelanoma skin cancers (NMSCs) pose a unique set of challenges. Basal cell carcinoma (BCC) is the most common malignancy in this area, with squamous cell carcinoma (SCC) second in frequency. BCC is characterized by its propensity for local aggressive growth and the capacity to reach large sizes (greater than 2 cm). SCC is the second most common cutaneous malignancy and is differentiated from BCC by its tendency to spread to regional lymph nodes (15% in tumors greater than 2 cm) and for perineural invasion (2%-15%). While considered a histological subtype of BCC, basosquamous carcinoma (BSCC) is abbreviatioNs BCC = basal cell carcinoma; BSCC = basosquamous cell carcinoma; CN = cranial nerve; MDACC = MD Anderson Cancer Center; NMSC = nonmelanoma skin cancer; OS = overall survival; PFS = progression-free survival; SCC = squamous cell carcinoma. obJect A relative paucity of information exists regarding outcomes from craniofacial resection for advanced nonmelanoma skin cancers involving the skull base. In light of advances in surgical technique and adjuvant therapy protocols, the authors reviewed their surgical experience to determine disease control rates, overall survival (OS), morbidity, and mortality. methods A retrospective review of 24 patients with nonmelanoma cutaneous cancers with skull base involvement treated with craniofacial resection at The University of Texas MD Anderson Cancer Center from 1994 to 2012 was performed. Of these patients, 19 (79%) had squamous cell carcinoma (SCC), 4 (17%) had basosquamous carcinoma (BSCC), and 1 patient (4%) had adenocarcinoma. Factors as assessed were prior treatment, TNM staging, tumor involvement, extent of intracranial extension, margin status, postoperative complications, recurrence, disease status at last follow-up, and long-term survival. The majority of tumors were T4 (67%) according to the TNM classification; perineural extension was noted in 58%, cavernous sinus involvement in 25%, and dural involvement in 29%. results Postoperative complications occurred in 4 patients (17%) including 1 death. Kaplan-Meier estimates were calculated for OS and progression-free survival (PFS). Median OS was 43.2 months with an 82% 1-year OS and 37% 5-year OS; the median PFS was 91.2 months. Margin status was positively associated with median OS in SCC (91 months [for negative margins] vs 57 months, p = 0.8) and in BSCC (23.7 vs 3.2 months, p < 0.05). Postoperative radiotherapy was associated with improved median OS (43.2 vs 22 months, p = 0.6). Brain involvement was uniformly fatal after 1 year, while cavernous sinus involvement (31 vs 43 months, p = 0.82), perineural disease (31 vs 54 months, p = 0.30), and T4 stage (22 vs 91.2 months, p = 0.09) were associated with worsened OS. Similar associations were found with median PFS. coNclusioNs Aggressive multimodality management with surgery and postoperative radiotherapy can positively...

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Section: Discussionmentioning

confidence: 99%

“…We previously reported our experience with a cohort of 35 patients who underwent surgery from 1982 through 1993. 1 In light of surgical advancements and shifts in adjuvant therapy protocols, we reviewed our experience from 1994 through 2012; primary outcomes assessed were overall survival (OS), progression-free survival (PFS), and short-term surgical outcomes.…”

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confidence: 99%

Nonmelanoma cutaneous cancers involving the skull base: outcomes of aggressive multimodal management

Raza¹,

Ramakrishna²,

Weber

et al. 2015

JNS

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“…Occasionally, skin cancers may be exceptionally aggressive, invading deeper anatomical planes and destroying soft tissues, bone and even the dura mater and brain. Some authors have recently reported their experience with skin carcinomas with skull base involvement [3] . In some published Brazilian skull base surgery series, they represent the main histological types of tumor [4][5][6] .…”

Section: Introductionmentioning

confidence: 99%

“…Perineural invasion has been considered an ominous prognostic factor in skin carcinomas [3,[8][9][10][11][12] , especially when this invasion was detected by clinical and/or radiological findings [11,13,14] .…”

Section: Introductionmentioning

confidence: 99%

Perineural Invasion in Aggressive Skin Carcinomas of the Head and Neck

Cernea¹,

Ferraz²,

Castro

et al. 2008

ORL

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Introduction: Perineural invasion is a well-recognized form of cancer dissemination. However, it has been reported only in few papers concerning cutaneous carcinomas (basal cell, BCC, and squamous cell, SCC). Moreover, the incidence is considered to be very low. Niazi and Lambert [Br J Plast Surg 1993;46:156–157] reported only 0.18% of perineural invasion among 3,355 BCCs. It is associated with high-risk subtypes, as morphea-like, as well as with an increased risk of local recurrence. No paper was found in the literature looking for perineural invasion in very aggressive skin cancers with skull base extension, with immunohistochemical analysis. Methods: This is a retrospective review, including 35 very advanced skin carcinomas with skull base invasion (24 BCCs and 11 SCCs, operated on at a single institution from 1982 to 2000). Representative slides were immunohistochemically evaluated with antiprotein S-100, in order to enhance nerve fibers and to detect perineural invasion. The results were compared to 34 controls with tumors with a good outcome, treated in the same time frame at the same Institution. Results: Twelve (50.0%) of the BCCs with skull base invasion had proven perineural invasion, as opposed to only 1 (4.6%) of the controls, and this difference was statistically significant (p < 0.001). Regarding SCCs, 7 aggressive tumors (63.6%) showed perineural invasion compared to only 1 (10.0%) of the controls, but this difference did not reach significance (p = 0.08), due to the small number of cases. Conclusions: In this series, it was demonstrated that immunohistochemically detected perineural invasion was very prevalent in advanced skin carcinomas. In addition, it was statistically associated with extremely aggressive BCCs with skull base invasion.

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“…(Backous, DeMonte et al 2005). Backous used as contraindication criteria for this type of resection encasement of the carotid artery or optic chiasm, cavernous sinus invasion or distant metastasis.…”

Section: Treatment Of Primary Tumormentioning

confidence: 99%