Squamous cell carcinoma of the skin surgery
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Squamous cell carcinoma of the skin Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2], Raviteja Guddeti, M.B.B.S. [3]
Overview
Surgery is the most widely used management of choice for high risk Squamous cell carcinomas (SCC). Two types of Surgical methods exist which are Surgical excision and Moh's micrographic surgery.
Surgery
- Squamous cell carcinoma are most commonly treated with surgery or radiation therapy
- However, consideration of function, cosmetic outcome, and patient preference may cause RT to be chosen as primary treatment to achieve optimal overall results. The algorithms list all of the therapies currently used to treat localized NMSC, including surgical techniques (i.e., curettage and electrodesiccation, excision with postoperative margin assessment [POMA], Mohs surgery or excision with “complete circumferential peripheral and deep-margin assessment” [CCPDMA]), RT, and superficial therapies.
- urettage and Electrodesiccation
- Excision With Postoperative Margin Assessment
- Regional Lymph Node Dissection
For patients with squamous cell carcinoma, regional nodal involvement significantly increases the risk of recurrence and mortality.116 If there are positive findings on either FNA or open biopsy of a lymph node, the preferred treatment is regional lymph node dissection following the corresponding pathway for the head and neck region (see page 845) or the trunk and extremity region (see page 846). Radiation alone is an alternative when surgery is not initially feasible; however, after radiation, patients should be reevaluated for neck dissection candidacy
- Surgical excision is the most widely used treatment of choice in high risk SCCs. It is well tolerated, extremely effective and completeness of the procedure can be confirmed by assessing the margins of the lesion histologically. Deeply invasive and metastatic lesion require more wide excision and exploration of the adjacent nodes. Cure rates with method approach 92% and 77% for primary and recurrent SCCs at the end of 5 years. Well defined, small (< 2 cm) lesions without any high risks the margin of the normal tissue around the tumor mass that is required during excision is 4mm. For larger, high risk lesions the margin has to be wide to make sure no residual lesion is left over after excision.
- Moh's micrographic surgery is particularly effective for high-risk localized cutaneous SCCs and SCCs located in cosmetically sensitive or critical areas because of its high cure rate and ability to spare normal tissue. 5 year cure rates for primary and recurrent tumors are 97% and 90% - 94% respectively. It is performed in the out patient setting and is well tolerated.[1] The procedure is performed in stages and the lesion is excised at an oblique angel along with a small rim of normal tissue. Histological assessment is then done and if the margins of the specimen test positive for tumor cells the locations are noted on Mohs map and a repeat procedure is done in the involved area itself and this process is repeated until the margins are clear of any tumor cells. This procedure is some what prolonged and take 2-4 hrs to complete. While Mohs surgery is frequently utilized and often considered the treatment of choice for squamous cell carcinoma of the skin, physicians have utilized the method for the treatment of squamous cell carcinoma of the mouth, throat, and neck.[2]
References
- ↑ Drake LA, Dinehart SM, Goltz RW; et al. (1995). "Guidelines of care for Mohs micrographic surgery. American Academy of Dermatology". J. Am. Acad. Dermatol. 33 (2 Pt 1): 271–8. PMID 7622656. Unknown parameter
|month=ignored (help) - ↑ Gross, K.G., et al. Mohs Surgery, Fundamentals and Techniques. 1999, Mosby.