title: Combined treatment of advanced stages of recurrent skin cancer of the head.
abstract: OBJECTIVE
  The authors investigated whether skull base resection and primary free-flap reconstruction in a single-stage surgery is oncologically effective for treating advanced stages of recurrent skin cancer (RSC) of the head.
  
  
  METHODS
  Eighteen consecutive patients were surgically treated. Twelve of them underwent an anterolateral skull base resection, which was performed using a pterional craniotomy combined with an orbitozygomatic osteotomy. Six patients underwent a posterolateral skull base resection, which was performed using an asterional craniotomy combined with a retrolabyrinthine petrosectomy. The wide postoperative defects were covered with muscular or myocutaneous free flaps. The main factor influencing survival was the extent of the resection: patients with no or minimal residual disease showed a statistically significant longer survival time than those with consistent residual disease. Basal cell carcinoma had a better prognosis than squamous cell carcinoma. A trend toward improved survival was observed in patients classified as T4M0 with negative lymph nodes (N0), but this trend was not statistically significant. Adjuvant radiotherapy significantly influenced both survival time and the rate of local recurrence. The surgical morbidity rate was 27.8%; there were two transient cerebrospinal fluid leaks and three seventh cranial nerve injuries. Late complications included radionecrosis in one patient and skin erosion requiring a second surgery in another patient. No deaths occurred during a 30-day postoperative period.
  
  
  CONCLUSIONS
  Advances in skull base surgery and free-flap reconstruction allowed the authors to treat patients with advanced-stage RSC of the head in a rather satisfactory manner. Only when it is impossible to achieve no or minimal residual disease should aggressive treatment be considered.
authors.affiliation: Department of Neurosurgery, Catholic University School of Medicine, Rome, Italy. apompucci@rm.unicatt.it
authors.forename: Angelo
authors.initials: A
authors.lastname: Pompucci
authors.forename: Giancarla
authors.initials: G
authors.lastname: Rea
authors.forename: Eugenio
authors.initials: E
authors.lastname: Farallo
authors.forename: Marzia
authors.initials: M
authors.lastname: Salgarello
authors.forename: Antonino
authors.initials: A
authors.lastname: Campanella
authors.forename: Eduardo
authors.initials: E
authors.lastname: Fernandez
mesh_terms: D000368:Aged; D002280:Basal Cell Carcinoma / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications; D018714:Radiotherapy, Adjuvant; D019651:Plastic Surgery Procedures / Q000379:methods; D012878:Skin Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D019291:Skull Base / Q000601:surgery*; D013524:Surgical Flaps; D016019:Survival Analysis; D016896:Treatment Outcome