The head and neck malignant tumor pathology can be addressed by multiple medical specialists: maxillofacial surgeons, dermatologists and plastic surgeons.
CARCINOMUL CU CELULE MERKEL
Although considered a less aggressive type of malignancy, the basal-cell carcinoma can extend to profound regions and require extensive surgery and immediate reconstructions of the defect area with regional or distant flaps. Keywords basal-cell carcinoma, surgical extirpation, relapse, local flap Rezumat Tegumentul poate fi afectat de tumori maligne, cu preponderenţă carcinomul bazocelular, urmat de cancer mamar catele metastatic cancer and skin şi melanomul malign.
Patologia tumorală malignă din zona capului şi a gâtului se află la graniţa dintre multiple specialităţi: chirurgie maxilo-facială, dermatologie, chirurgie plastică. Deşi considerat o formă mai puţin agresivă local, carcinomul bazocelular poate avea o evoluţie locoregională infiltrativă în părţile profunde, implicând rezecţii largi şi reconstrucţie imediată cu lambouri locoregionale sau de la distanţă.
Cuvinte cheie carcinom bazocelular extirpare extinsă recidivă lambou local Introduction Skin cancer is the metastatic cancer and skin frequent malignancy worldwide. The most encountered histological subtypes are basal-cell carcinoma and squamous cell carcinoma. Metastatic cancer and skin inin USA, up to 5 million patients received treatment for these two types of cancer 1. Australia has the highest number of new cases of skin cancer in the world 2due to climate extensive sun exposure ; metastatic cancer and skin vast majority of skin malignant tumours are UV radiation metastatic cancer and skin.
From the histological perspective, the most encountered is basal-cell carcinoma, followed by squamous cell carcinoma. The management of skin malignancies is divided into two major branches: surgery radical tumor resection, Mohs surgery, electrodessicationand conservative treatment photodynamic therapy, radiotherapy, cryotherapy and topical agents.
Surgical treatment is the first intended treatment when dealing with skin cancer, and the excision should be tailored to ensure proper free margin around the tumor, of at least 6 mm. If the lesion is found to be generated from the squamous layer, the lymph nodes should also be investigated.
Urmărirea pacienţilor cu carcinom bazocelular
metastatic cancer and skin The metastatic cancer and skin or lymph metastasis risk is associated with the characteristics of the tumour: histological subtype, size, profound invasion, localization, and also the general condition of the patients immunosuppression, severe associated diseases.
The tumors associated with a high risk of relapse or metastases have poor differentiated morphology, have more than 2 cm in size, and are situated in the eye or in perioral region 4.
Case presentations Case I An year-old male patient was admitted to our department for a frontal region tumor developed approximately six months ago Figure 1. The patient had a medical history in our records: 12 years ago he received a right orbital exenteration for an advanced basal-cell carcinoma.
The biopsy confirmed a secondary basal-cell carcinoma. A surgical plan was established: wide surgical excision and immediate reconstruction of the defect with metastatic cancer and skin horizontal frontal flap Figure 1.
The healing went uneventful, and the histological examination confirmed the basal-cell carcinoma. The importance of the case lies in the development of a second basal-cell carcinoma, on the same side, 12 years after the primary tumor.
În fiecare an, aproximativ 2.
Frontal basal-cell carcinoma 12 years after exenteration Figure 1. Upper left: the flap design for reconstruction; lower left: flap in place; right: follow-up at 6 months Case II An year-old female patient was sent to our department by her general practitioner for an ulcerated left cheek tumor, with a five-year onset Figure 2.
And you know those cerebral metastases that you have
After the clinical and computed tomography examinations Figure 2. The ophthalmic examination revealed important eyesight impairment.
The patient did not have other illnesses. Figure 2. Basal-cell carcinoma of the cheek area involving the orbit and the nose regions Figure 2.
REDUCEREA NUMĂRULUI DE NEVOI IMPERIOASE PENTRU PACIENȚII CU CARCINOM CU CELULE MERKEL
CT scan showing bony and orbit extension of the tumor The biopsy confirmed the clinical diagnosis: basal-cell carcinoma. A surgical procedure was planned: wide surgical excision en bloc with left exenteration and anterior maxillary wall resection, and immediate reconstruction of the soft tissue defect with frontal and advanced cheek flap Figure 2.
A second-stage procedure will be carried on after three weeks for adjusting the frontal metastatic cancer and skin pedicle. Healing went uneventful Figure 2. The patient refused other surgical procedures.
Surgical specimen, the defect, and the flap design Figure 2. Immediate postoperative image and after suture removal Discussion There are numerous reports in literature that show an increase in skin cancer incidence, but an exact number cannot be determined because of a variety of factors: not all excised specimens are sent for histological examination, many patients are treated in one-day surgery procedures in private centres that do not usually report all their malignant cases and, last but not least, because skin malignancies are often seen in elderly patients which metastatic cancer and skin not receive adequate treatment due to their health condition.
Topical agents such as fluorouracil or imiquimod have been used for treating skin cancers, but it appears that there is a good prognosis only in premalignant phases and in small basal-cell carcinomas 7. Even in these cases, the reports contain small groups of patients, lacking the statistical relevance of large cohorts.
Metastatic cancer and skin is best suited for a palliative method of treatment in patients who are not good candidates for surgical treatment.
Follow-up in advanced basal-cell carcinoma
Radiotherapy can enhance the prognosis when dealing with relapse or node involvement, when it is used after the surgical treatment in the multimodal treatment of skin cancers. For patients who refuse surgical resection due to cosmetic reasons, radiotherapy can be used as a primary intention treatment, but the patient should be advised that there is a lower chance of curative intention comparative with surgery. For late stages metastatic cancer and skin squamous cell carcinomas with lymph node involvement, the most efficient therapy metastatic cancer and skin the surgical treatment resection and neck dissection followed by radiotherapy.
When dealing with N0 stages, neck management must be carefully planned and the cervical nodes should be addressed when there is perineural or perivascular infiltration, poorly differentiated histological types, immunosuppression, more than 2 cm in size or 8 mm depth of the primary tumor Patients who have developed a skin malignancy pose a greater risk of acquiring a second test papillomavirus homme in time and they are three times more likely to develop a malignant melanoma Specialists recommend to have check-ups twice a year and protection against UV.
The various drug therapies have not yet been proved to play a major role in fighting relapse or metastasis. Conclusions The European population tends to get older and as skin cancers are age-dependent, the clinicians will have to deal in the future with an increasing number of patients.
The vast majority of skin malignancies are found in the head and neck regions, where multiple medical specialists exert their profession, but a better collaboration between professions will ensure a better prognosis for these patients. Conflict of interests: The authors declare no conflict of interests.
Traducere "metastaze pe care le" în engleză
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Urmărirea pacienţilor cu carcinom bazocelular
The risk of progression to invasive disease. Socioeconomic status and non-melanoma skin cancer: a nationwide cohort study of incidence and survival in Denmark. Cancer Epidemiol. Dermatol Surg.
Hall VL, et al. Treatment of basal-cell carcinoma: comparison of radiotherapy and cryotherapy.
Clin Radiol. Radical radiotherapy for T4 carcinoma of the skin of the metastatic cancer and skin and neck: a multivariate analysis. Head Neck.
Jul-Aug ; 15 4 Developments in the treatment metastatic cancer and skin locally advanced and metastatic squamous cell carcinoma of the skin: a rising unmet need. Non-melanoma skin cancer and subsequent cancer risk.