Skull Base and Intracranial Invasion Patterns and Survival Outcomes of Non-Melanoma Skin Cancers

Dündar, Yusuf; Cannon, Richard B.; Monroe, Marcus M.; Buckman, Luke; Hunt, Jason P.

doi:10.1055/s-0036-1579792

Cited by 4 publications

(9 citation statements)

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“…We have described skull base invasion patterns and survival outcomes of nonmelanoma skin cancers and found that the route and extent of skull base invasion significantly affect disease-specific and overall survival. 10 For these patients, the success of initial surgical treatment relies heavily on accurate clinical judgment of the magnitude of disease spread to achieve resection with negative margins. 11 Magnetic resonance imaging (MRI) can delineate large nerve perineural spread classified according to the degree of skull base involvement 12 and is valuable for determining zonal classification: peripheral (zone 1), skull base (zone 2), and central (zone 3).…”

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confidence: 99%

“…13,14 This classification correlates with disease-specific and overall survival. 10 Rates of regional metastasis after skull base invasion due to cSCC are not well studied, and the benefit of an END in these patients is not known. Our goal is to identify factors associated with END and to investigate the survival difference in these patients treated with an END compared with observation for the cN0 neck.…”

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confidence: 99%

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Elective Neck Dissection for Head and Neck Cutaneous Squamous Cell Carcinoma with Skull Base Invasion

Cannon

Dündar

Thomas

et al. 2017

Otolaryngol.--head neck surg.

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Objectives Skull base invasion from cutaneous squamous cell carcinoma (cSCC) via perineural spread affects survival and the rate of regional metastasis. Our objective is to investigate the factors associated with elective neck dissection (END) in this population and the survival difference with END compared with observation for patients with a cN0 neck. Study Design Case series with chart review. Setting Academic. Subjects and Methods Patients were treated surgically for head and neck cSCC with skull base invasion via perineural spread with a cN0 neck from 2004 to 2014. Clinicopathologic data were collected and analyzed. Primary outcomes were disease-free survival (DFS) and overall survival (OS). Results Fifty-nine patients met inclusion criteria: 28 underwent an END and 31 underwent neck observation. Free tissue transfer reconstruction was significantly associated with END ( P < .001). Patients treated with an END had significantly improved 5-year DFS (57% and 32%, P = .042) and OS (60% and 37%, P = .036) compared with those who were observed and a significantly reduced rate of regional recurrence (9% and 37%, P = .024). The rate of occult nodal metastasis identified with END was 36% and is approximately equal to the regional failure rate of the neck observation group (37%). Conclusion END was more commonly used in cases requiring free tissue transfer. The use of END for head and neck cSCCs that have invaded the skull base is not routinely performed but was found to be associated with a survival advantage and reduced regional recurrence rate.

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confidence: 99%

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confidence: 99%

Elective Neck Dissection for Head and Neck Cutaneous Squamous Cell Carcinoma with Skull Base Invasion

Cannon

Dündar

Thomas

et al. 2017

Otolaryngol.--head neck surg.

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“…The survival outcomes of advanced nonmelanoma skin cancers from national databases are generally lacking 18 . The 5-year survival of stage III/IV cutaneous SCC in a study examining 642 patients conducted in the Netherlands was 62% and 46% in male and female patients, respectively.…”

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confidence: 99%

Locally Advanced Scalp Tumors

et al. 2021

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Introduction Locally advanced nonmelanoma skin cancers of the head and neck are well described in the current literature. However, data about clinical and survival outcomes are lacking. We present survival data from a tertiary head and neck cancer unit in London. Methods A retrospective analysis of data collected from a single institution was conducted. All patients with locally advanced cutaneous scalp carcinomas invading the skull between 2011 and 2019 were included. Data included patient demographics, tumor, comorbidities, interventions, flap survival, and metal work exposure. Survival outcomes were examined using Kaplan-Meier analysis. Results Twenty-three patients were identified. The mean age was 72 years. Eighteen patients were male, and 5 were female. Five patients were immunosuppressed. Nineteen patients underwent outer cortex drill-down/full-thickness calvarial resection, followed by reconstruction with free tissue transfer. Six patients had titanium mesh reconstruction after segmental skull resections. Three patients underwent further surgery because of exposed metalwork. Disease-free survival at 3 years after surgery was 60%. Conclusions Locally advanced nonmelanoma skin cancers invading the bone are sporadic. There are little published data on clinical and survival outcomes in this group. Despite the nature of these skin lesions, a high degree of local control can be obtained by extensive surgical resection, outer table drill-down, and calvarial resection. We conclude that aggressive management of the bony invasion improves disease-free survival and improves local control.

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“…Direct invasion of the skull base is the most common invasion pattern of BCC and is commonly observed at the scalp, whereas PNS with extension to the skull base predominantly occurs in SCC [8]. When small nerves are invaded by the tumor and are only detectable by microscopy, it is called incidental perineural invasion (PNI), and when clinically or imaging findings suggest nerve invasion, it is called clinical PNI or PNS [8]. PNS is an uncommon pattern for skin cancers with an incidence of approximately 3%.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Dundar et al [8] evaluated ninety NMSC patients with skull base invasions (68/90 or 76% of SCC) during a 10 years period and identified that 82% of the patients were already subjected to a prior treatment before the skull base invasion (all of them had previously had surgery and 17% also had radiotherapy). Additionally, 38% of the patients had direct skull invasion, and 69% had invasions through PNS (63% via cranial nerves V and VII and 37% via intracranial nerves).…”

Section: Clinical Presentationmentioning

confidence: 99%

Comprehensive management of nonmelanoma skin cancer involving the skull base

Matos

Cernea

2021

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of reviewSkin cancers are the most prevalent malignant disorder affecting humans. Approximately 90% of these are nonmelanoma skin cancer (NMSC), and large tumors, especially at the 'H-zone', can invade deeply and access the skull base. The best treatment for these very advanced skin cancers is craniofacial resection followed by adjuvant treatment, but, currently, systemic therapy and neoadjuvant approaches could be considered for some patients. The current management of NMSC involving the skull base is discussed in this article. Recent findingsSurgical resections with negative margins followed by adjuvant treatment are the best treatment for NMSC with skull base invasion and offer the best outcomes for those patients. This approach usually requires a free flap reconstruction, followed by external beam radiation therapy. The team must keep in mind that some factors, such as gross brain invasion and extensive dura mater extension, are associated with worse outcomes.

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Skull Base and Intracranial Invasion Patterns and Survival Outcomes of Non-Melanoma Skin Cancers

Cited by 4 publications

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Elective Neck Dissection for Head and Neck Cutaneous Squamous Cell Carcinoma with Skull Base Invasion

Elective Neck Dissection for Head and Neck Cutaneous Squamous Cell Carcinoma with Skull Base Invasion

Locally Advanced Scalp Tumors

Comprehensive management of nonmelanoma skin cancer involving the skull base

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