Management of Nasal Cutaneous Malignant Neoplasms: An Interdisciplinary Approach

Abstract

\s=b\Standard methods of managing large or recurrent cutaneous nasal malignant neoplasms are often inadequate, leaving extensions of the tumor that are clinically invisible. Conventional methods may also allow considerable amounts of normal tissue to be sacrificed in an attempt to ensure the removal of all carcinoma.Through partnership of the dermatologic surgeon and the reconstructive surgeon, a more effective method of curing and rehabilitating patients with nasal skin cancer can be achieved. The dermatologic Mohs' surgeon can perform microscopically controlled excision of malignant neoplasms, providing the highest cure rates obtained by any method. This method is particularly suited for basal cell carcinomas that are recurrent, larger than 1 cm in size, or are of the morpheaform histologic subtype. Total microscopic excision allows nasal reconstruction to proceed with the highest degree of confidence of tumor control. The location and extent of the malignancy dictate the surgical approach for nasal reconstruction. (Arch Otolaryngol 1983;109:473-479) Skin cancer is the most common form of malignancy in man. The nose is the most common site of skin cancer and also is one of the most difficult areas on which to effect a cure. A recent review of 2,600 patients with cancer of the skin of the head and neck area demonstrated that bas¬ al cell carcinoma was the predomi¬ nant histological type (69%). Approx¬ imately 12% of the patients had can¬ cers of the nasal skin.1 Of the 305 patients with a nasal skin cancer, only 64% of the tumors were confined strictly to the skin of the nose. Approximately 40% of all recalci¬ trant basal cell carcinomas of the head and neck involve nasal skin.2 This is, in part, related to multiple embryologie fusion planes occurring in the nasal region that offer paths of decreased resistance to the spread of neoplasm.3 Conventional methods of managing nasal cutaneous malignant neoplasms included electrodesiccation and curettage, cryosurgery, radiotherapy, and surgical excision. Electrodesiccation and curettage and cryosurgery are acceptable methods of managing small tumors less than 0.5 cm in diam¬ eter. However, they are not as effec¬ tive for larger tumors and other modalities should be used.Radiotherapy offers a high cure rate for basal cell and squamous cell carcinomas of the nasal skin. Surgical excision is also a good method for small cutaneous malignant neoplasms of the nose where flaps and grafts are required for closure. More extensive tumors treated with surgery should make use of an extended follow-up period of six to 12 months before reconstructive procedures are initi¬ ated.Another method of managing nasal cutaneous malignant neoplasms is by microscopically controlled excision (Mohs' surgery). The cornerstone of this surgical method is total micro¬ scopic control of excision. Using local Downloaded From: http://archotol.jamanetwork.com/ by a Oakland University User on 05/31/2015

An approach to managing non-melanoma skin cancer of the nose with mucosal invasion: our experience

“…Approximately 25% of head and neck skin cancers develop in the nasal pyramid [1]. The main locations are the nasal ala (45%), dorsum (17%) and tip (5.5%) [2]. BCCs and SCCs are the most common nasal skin cancers, with a rate of 70Á90% and 10Á30% respectively, and malignant melanoma and other uncommon neoplasms account for approximately 5% [1Á4,16].…”

“…The nasal pyramid is the most common site for the presentation of head and neck cutaneous malignancies, particularly in sun-exposed areas sucha as the ala, dorsum and tip of the nose [1,2]. Basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) are mainly observed.…”

“…In comparison to other skin sites, the nose is the most frequent site of recurrence following ablation of skin cancers [1,5]. According to tumour characters several therapeutic approaches have been proposed: electrodessication and curettage, cryosurgery, radiotherapy, traditional surgery and Mohs' surgery [2]. It was our purpose, in a prospective study, to validate a therapeutic strategy aiming for oncological safety and minimization of possible recurrences after full-thickness excision of nasal non-melanocytic skin cancers (NMSCs) with mucosal invasion.…”

The use of folded melolabial interpolation flaps to repair full thickness distal nasal defects: A review of technique and results

“…Of these skin cancer cases, a large proportion occur on the nose [3,4] . The nose plays an important role with regards to normal breathing-maintaining the patency of the external nasal valve is critical in mitigating airway resistance.…”

Options for Internal Lining in Nasal Reconstruction

“…Failure to confirm clear margins risks tumor recurrence, rendering moot the successful nasal reconstruction. Mohs micrographic surgery 3,4 lends itself to immediate confirmation of clear margins. Wide local excision, on the other hand, relies on frozen-section analysis of a representative sample of the defect margin or delayed reconstruction, allowing time to confirm negative margins of permanent pathologic specimens.…”