Craniofacial surgery for nonmelanoma skin malignancy: report of an international collaborative study.
BACKGROUND
This study examined the efficacy of craniofacial surgery (CFS) in treating locally advanced nonmelanoma skin cancer (NMSC).


METHODS
One hundred twenty patients who underwent CFS for NMSC were identified from 17 participating institutions. Patient, tumor, and treatment information was analyzed for prognostic impact on survival.


RESULTS
Surgical margins were negative in 74%, close in 3%, and involved in 23% of patients. Complications occurred in 35% of patients, half of which were local wound problems. Operative mortality was 4%. Median follow-up interval after CFS was 27 months. The 5-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) rates were 64%, 75%, and 60%, respectively. Squamous cell histology, brain invasion, and positive resection margins independently predicted worse OS, DSS, and RFS.


CONCLUSIONS
CFS is an effective treatment for patients with NMSC invading the skull base. Histology, extent of disease, and resection margins are the most significant predictors of outcome.
Maghami
Ellie G
EG
Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Talbot
Simon G
SG
Patel
Snehal G
SG
Singh
Bhuvanesh
B
Polluri
Ashok
A
Bridger
Patrick G
PG
Cantu
Giulio
G
Cheesman
Anthony D
AD
De Sa
Geraldo
G
Donald
Paul
P
dos Santos
Luiz R M
LR
Fliss
Dan
D
Gullane
Patrick
P
Janecka
Ivo
I
Kamata
Shin-Etsu
SE
Kowalski
Luiz P
LP
Kraus
Dennis H
DH
Levine
Paul A
PA
Pradhan
Sultan
S
Schramm
Victor
V
Snyderman
Carl
C
Wei
William I
WI
Shah
Jatin P
JP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D002280:Basal Cell Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011183:Postoperative Complications; D018714:Radiotherapy, Adjuvant; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D012888:Skull Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D013524:Surgical Flaps