Intraoperative use of Mohs' surgery for the resection of major cutaneous head and neck cancer under general anaesthetic: Initial experiences, efficiency and outcomes.
BACKGROUND
Complete excision of high-risk extensive non-melanoma skin cancers in the head and neck is paramount to achieving loco-regional control. However, achieving clear margins still remains a significant challenge. Mohs' micrographic surgery (MMS) provides the most accurate method of intraoperative mapping and histological assessment of tumour margins. We have developed a technique combining MMS with reconstruction as a single-stage procedure performed under general anaesthetic. We present our experience and results.


METHODS
Following regional skin cancer multidisciplinary team (MDT) discussion, patients considered appropriate for management as a single-stage combined procedure were referred for assessment. At surgery, a two-team approach was employed consisting of an MMS resection team and a reconstructive team, allowing simultaneous resection and elevation of any free tissue required for reconstruction. Outcome data were retrieved from a prospectively collated MMS database.


RESULTS
Twenty-six cases were performed between January 2010 and January 2013. Fifty-eight percent of cases were basal cell carcinomas. Clear margins were achieved in 50% of cases following the first Mohs' layer. Free tissue reconstruction was required in 13 cases. Mean anaesthetic time was 445 min. Loco-regional control was achieved in 96% of patients, at a mean follow-up period of 29 months (range 11-50 months).


CONCLUSIONS
This study shows that the combined single-stage MMS and reconstruction surgical model is safe, results in a low recurrence rate and improved patient care. It is a model that can be replicated in other tertiary skin cancer units.
Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK. Electronic address: hyder.ridha@gmail.com.
Hyder
H
Ridha
Department of Dermatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK; University of East Anglia, Norwich, UK.
Jennifer J
JJ
Garioch
Department of Dermatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
Eunice K
EK
Tan
Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK.
Martin J
MJ
Heaton
Department of Pathology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
Laszlo
L
Igali
Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK; University of East Anglia, Norwich, UK.
Marc D
MD
Moncrieff
D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D012878:Skin Neoplasms / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome
Head and neck non-melanoma skin cancer; Head and neck reconstruction; Mohs' surgery; Skin pathology