Craniofacial resection for nonmelanoma skin cancer of the head and neck.
OBJECTIVE
We reviewed our experience with craniofacial resection for advanced, nonmelanoma skin cancer of the head and neck to determine prognostic factors, local control rate, disease free survival, morbidity, and mortality.


METHODS
Retrospective review of consecutive patients treated at a tertiary referral center from 1982 to 1993.


METHODS
Charts of patients having craniofacial resection for aggressive nonmelanoma cutaneous malignancies were reviewed and living patients followed for 10 additional years. Demographics, histology, previous interventions, treatment, surgical pathology, reconstructions, and complications were examined. The product-limit method was used to calculate survival functions, and the log-rank test was used to compare survival distributions.


RESULTS
Thirty-five patients, mean age 66.7 years, received treatment at our facility. Follow-up ranged from 2 to 191 (mean 47.4) months. Histology included 20 squamous cell carcinomas (SCC) and 15 basal cell carcinomas (BCC). Sixty percent had craniofacial resection alone, and 28.6% also had postoperative radiotherapy. There were two perioperative deaths, and 37.1% suffered early and 14.3% late surgical complications. Two- and five- year survival was significantly better (P=.02) with BCC (92% and 76%) than with SCC (54% and 24%). Long-term disease-specific survival was 20%, and 11.4% of our subjects were living with disease. Intracranial extension (P=.02), perineural invasion (P=.049), and prior radiotherapy significantly decreased 5-year survival.


CONCLUSIONS
Acceptable mortality and morbidity is possible using craniofacial resection to treat advanced nonmelanoma skin cancer. Although disease-specific survival remains poor, positive trends were noted in local control beginning at 2 years of follow-up. Because patients often have few remaining options for cure, craniofacial resection is justified when technically feasible.
Backous
Douglas D
DD
Section of Otolaryngology-Head and Neck Surgery, VA Mason Medical Center, Seattle, Washington 98111-0900, USA. otoddb@vmmc.org
DeMonte
Franco
F
El-Naggar
Adel
A
Wolf
Pat
P
Weber
Randal S
RS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D005145:Face; D005260:Female; D005500:Follow-Up Studies; D006257:Head / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate