The role of free tissue transfer in the reconstruction of massive neglected skin cancers of the head and neck

Mark Wax, Brian B. Burkey, Daphne Bascom, Eben L. Rosenthal

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Background: Most skin cancers involving the head and neck region are easily managed with surgical resection and local flap rotation. Occasional patients present with massive neglected skin cancers or skin cancers that have recurred after multiple treatments. Management of these massive tumors may involve craniofacial resection, maxillectomy, or mandibulectomy to obtain clear margins. Reconstruction requires massive composite soft tissue replacement. We presented our experience with, to our knowledge, the largest series reported to date. Design: A retrospective chart review of 43 patients with massive neglected skin cancer of the head and neck reconstructed by means of free tissue transfer from January 1, 1992, through October 1, 2001. Setting: Academic tertiary referral medical center. Results: Seventeen patients with squamous cell carcinoma and 26 patients with basal cell carcinoma were treated. Primary sites included the cheek (n=15), ear (n=8), forehead (n=5), neck (n=4), scalp (n=5), and nose (n=6). Treatment involved a combination of orbital exenteration (n=16), maxillectomy (n=12), mandibulectomy (n=6), auriculectomy (n=5), craniofacial resection (n=10), rhinectomy (n=6), and lateral temporal bone excision (n=5). Flaps used for reconstruction included the rectus abdominis (n=22), latissimus dorsi (n=11), radial forearm (n=8), and lateral arm (n=2). Radiotherapeutic exposure included pretreatment in 21 patients and posttreatment in 15. Twelve patients had undergone no previous surgeries; 15 patients, 1 to 5; and 16 patients, more than 5. Follow-up revealed evidence of local recurrence (n=12), locoregional recurrence (n=3), distant metastasis (n=3), and no evidence of disease (n=25). Conclusions: Massive skin cancers are generally associated with disfiguring, debilitating surgery and high mortality rates. We demonstrate that free tissue transfer yields acceptable survival with functional and cosmetic outcomes.

Original languageEnglish (US)
Pages (from-to)479-482
Number of pages4
JournalArchives of Facial Plastic Surgery
Volume5
Issue number6
DOIs
StatePublished - 2003

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Skin Neoplasms
Head and Neck Neoplasms
Recurrence
Rectus Abdominis
Forehead
Superficial Back Muscles
Cheek
Temporal Bone
Basal Cell Carcinoma
Scalp
Nose
Forearm
Tertiary Care Centers
Cosmetics
Ear
Squamous Cell Carcinoma
Arm
Neck
Neoplasm Metastasis
Survival

ASJC Scopus subject areas

  • Surgery

Cite this

The role of free tissue transfer in the reconstruction of massive neglected skin cancers of the head and neck. / Wax, Mark; Burkey, Brian B.; Bascom, Daphne; Rosenthal, Eben L.

In: Archives of Facial Plastic Surgery, Vol. 5, No. 6, 2003, p. 479-482.

Research output: Contribution to journalArticle

Wax, Mark ; Burkey, Brian B. ; Bascom, Daphne ; Rosenthal, Eben L. / The role of free tissue transfer in the reconstruction of massive neglected skin cancers of the head and neck. In: Archives of Facial Plastic Surgery. 2003 ; Vol. 5, No. 6. pp. 479-482.
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abstract = "Background: Most skin cancers involving the head and neck region are easily managed with surgical resection and local flap rotation. Occasional patients present with massive neglected skin cancers or skin cancers that have recurred after multiple treatments. Management of these massive tumors may involve craniofacial resection, maxillectomy, or mandibulectomy to obtain clear margins. Reconstruction requires massive composite soft tissue replacement. We presented our experience with, to our knowledge, the largest series reported to date. Design: A retrospective chart review of 43 patients with massive neglected skin cancer of the head and neck reconstructed by means of free tissue transfer from January 1, 1992, through October 1, 2001. Setting: Academic tertiary referral medical center. Results: Seventeen patients with squamous cell carcinoma and 26 patients with basal cell carcinoma were treated. Primary sites included the cheek (n=15), ear (n=8), forehead (n=5), neck (n=4), scalp (n=5), and nose (n=6). Treatment involved a combination of orbital exenteration (n=16), maxillectomy (n=12), mandibulectomy (n=6), auriculectomy (n=5), craniofacial resection (n=10), rhinectomy (n=6), and lateral temporal bone excision (n=5). Flaps used for reconstruction included the rectus abdominis (n=22), latissimus dorsi (n=11), radial forearm (n=8), and lateral arm (n=2). Radiotherapeutic exposure included pretreatment in 21 patients and posttreatment in 15. Twelve patients had undergone no previous surgeries; 15 patients, 1 to 5; and 16 patients, more than 5. Follow-up revealed evidence of local recurrence (n=12), locoregional recurrence (n=3), distant metastasis (n=3), and no evidence of disease (n=25). Conclusions: Massive skin cancers are generally associated with disfiguring, debilitating surgery and high mortality rates. We demonstrate that free tissue transfer yields acceptable survival with functional and cosmetic outcomes.",
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