Surgery for Bowen Disease: Clinicopathological Factors Associated With Incomplete Excision

Background: One common treatment for Bowen’s disease (BD) is surgical excision, but there is no international consensus on the appropriate surgical margins. Objectives: This study examined what factors affect the rate of incomplete excision of BD. Methods: Clinicopathological data potentially linked to surgical outcome (complete or incomplete excision) were retrospectively collected from medical and histopathological records on all surgically excised BD lesions diagnosed at Sahlgrenska University Hospital in Gothenburg, Sweden during 2014-2015. Data were analyzed with two definitions of incomplete excision: less strict (ie, BD present at the surgical margin) and strict (ie, dysplasia present at the surgical margin). Results: In total, 463 BD lesions among 408 patients were included. With the less strict definition, 3 factors were associated with significantly higher rates of incomplete excision: surgical margins <3 mm, a less experienced surgeon, and use of punch biopsy excision. The same factors plus a tumor location on the head and neck area or upper extremities were associated with significantly higher rates of incomplete excision using the strict definition. After adjustment for confounders, less experience was independently associated with incomplete excision using the less strict definition, whereas less experience and location on the head and neck area or upper extremities were independently associated with incomplete excision using the strict definition. Surgeon specialty was not associated with incomplete excision regardless of the definition. Conclusions: When removing BD surgically, an elliptical excision with surgical margins ≥3 mm carried out by an experienced surgeon should be recommended. Surgical margins may need to be adjusted depending on body site.

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Effect of Formalin Fixation on Surgical Margins in Breast Cancer Surgical Specimen

International Journal of Breast Cancer ◽

10.1155/2014/121838 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 10

Author(s):

Masooma Zaidi ◽

Shaista Khan ◽

Najiha Bilal Farooqi ◽

Kashif Abbas ◽

Romana Idrees

Keyword(s):

Breast Cancer ◽

Surgical Margin ◽

Surgical Margins ◽

Formalin Fixation ◽

University Hospital ◽

Postoperative Treatment ◽

Cancer Type ◽

Surgical Specimen ◽

Free Margin ◽

The Mean

Margin analysis in breast surgery is an important predictor of local recurrence and can have vital impact on the postoperative treatment planning.Objective. The aim was to assess the mean reduction in the closest tumor-free surgical margin in millimeters of breast cancer specimens following formalin fixation.Materials and Methods. We conducted a cross-sectional study at the Aga Khan University Hospital from March 30, 2010 to January 20, 2011. One hundred consecutive breast tumour surgical specimens which had macroscopically visible tumour were included. The cancer type included both in situ and invasive cancers. Excluded were the patients who had previous surgery or systemic/radiation therapy. The closest tumor-free margin was recorded and compared with the margin after formalin fixation.Pvalue of <0.05 was considered significant.Results. The mean age of our 100 patients was 53 years with the majority of the patients having undergone mastectomy for predominantly invasive ductal carcinoma. Following formalin fixation, the mean reduction of the closest tumor-free margin was noted as 2.14 mm which was found statistically significant.Conclusion. Considerable shrinkage of tumor-free surgical margins of breast cancer specimen was noted after formalin fixation. This inference can have implications on the postoperative management plan.

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Pretreatment tumor sampling and prognostic factors in patients with soft-tissue sarcoma of the head and neck

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-07162-0 ◽

2021 ◽

Author(s):

Johan H. Roos ◽

Antti A. Mäkitie ◽

Jussi Tarkkanen ◽

Taru T. Ilmarinen

Keyword(s):

Prognostic Factors ◽

Soft Tissue ◽

Head And Neck ◽

Soft Tissue Sarcomas ◽

Surgical Margin ◽

Tumor Grade ◽

Tumor Location ◽

Margin Status ◽

University Hospital ◽

Tumor Sampling

Abstract Background Insufficient preoperative work-up and consequent intralesional or marginal resection of soft-tissue sarcomas of the head and neck (STSHNs) is common. Methods This retrospective cohort study comprised 63 patients with STSHN treated at the Helsinki University Hospital between 2005 and 2017. We assessed the effect of pretreatment tumor sampling on surgical margin status and need for supplemental surgery, as well as prognostic factors and survival. Results The lack of representative pretreatment biopsy specimen was associated with unfavorable margin status. Primary surgery at a non-academic center was associated with need for supplemental surgery. The 3-year overall survival (OS) was 68%, disease-specific survival (DSS) 71%, and recurrence-free survival (RFS) 61%. Higher tumor grade and primary tumor size over 5 cm were associated with reduced DSS. Conclusions Diagnosis and management of STSHNs should be centralized to experienced academic centers. Decision-making between needle biopsy, open biopsy, or upfront radical surgery depends on tumor location and size.

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Survival analysis between narrower surgical margins and guideline-recommended margins for excision of cutaneous squamous cell carcinoma: A multicenter, retrospective study of 1,204 Japanese cases.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.10063 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 10063-10063

Author(s):

Natsuki Baba ◽

Yasuhiro Nakamura ◽

Hiroshi Kato ◽

Shigeto Matsushita ◽

Noriki Fujimoto ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

High Risk ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Surgical Margin ◽

Cutaneous Squamous Cell Carcinoma ◽

Surgical Margins ◽

Free Survival ◽

Significant Difference

10063 Background: Controversy exists regarding the optimal surgical margin for cutaneous squamous cell carcinoma (cSCC). Current NCCN Guidelines recommend excision with a 4–6-mm clinical margin for low-risk cSCC and wider ( > 6-mm) clinical margin for high-risk cSCC tumors. However, adherence to this guideline is often difficult, as high-risk cSCCs frequently occur on the faces of elderly patients. Thus, we aim to investigate the correlation between different surgical margins and prognosis in patients with cSCC. Methods: Patients with cSCC who had undergone surgical excision of the primary site between 2011 and 2019 at 11 Japanese institutions were included in this study. Patients were divided into two groups: the standard margin group (SMG) with excisions adhering to the guideline-recommended margins, and narrower margin group (NMG) with excisions with narrower margins than are guideline-recommended. Local recurrence-free survival (LRFS), relapse-free survival (RFS), and overall survival (OS) were estimated using Kaplan–Meier analysis and compared between the two groups. Results: A total of 1204 patients with cSCC (SMG, 637; NMG, 567) were included in this study. RFS was significantly lower in SMG than in NMG (5-year RFS 72% vs 79%; P = 0.03); however, no statistically significant differences were observed between the two groups in LRFS (5-year LRFS 80% vs 82%; P = 0.41) or OS (5-year OS 84% vs 83%; P = 0.90). Due to striking statistical significance in several characteristics of patients between the two groups, subgroup analyses, focusing on the cohort of head and neck cSCCs, were also performed. The patient characteristics were similar between SMG and NMG in both the T1-sized tumor ( < 2 cm, SMG, 182; NMG, 250) and T2-sized tumor (2 cm ≤ tumor < 4 cm, SMG, 130; NMG, 136) cohorts, based on AJCC-TNM staging (8th edition). There were also no significant differences between the SMG and NMG in LRFS (5-year LRFS, T1: 80% vs 86%; P = 0.59; T2: 85% vs 84%; P = 0.84), RFS (5-year RFS, T1: 80% vs 81%; P = 0.84; T2: 77% vs 76%; P = 0.99), or OS (5-year OS, T1: 82% vs 87%; P = 0.42; T2: 88% vs 85%; P = 0.68). Furthermore, when the NMG was divided into the two margin groups (margins reduced by < 3 mm or ≥3 mm from the standard margin), no significant difference was observed in LRFS, RFS, and OS. Conclusions: This study did not reveal a significant impact of the size of clinical excision margins on survival in patients with cSCCs. Strikingly, the narrower margins may be more appropriate for < 4 cm-sized head and neck cSCCs.

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Faculty Opinions recommendation of Surgical margins in head and neck squamous cell carcinoma: what is 'close'?

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717969700.793470085 ◽

2013 ◽

Author(s):

Iain Nixon

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Surgical Margins ◽

Neck Squamous Cell Carcinoma

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Complications after Functional Neck Dissection in Head and Neck Cancer Patients: An Observational, Retrospective, Single-Centre Study

ORL ◽

10.1159/000514459 ◽

2021 ◽

pp. 1-9

Author(s):

Carlos M. Chiesa-Estomba ◽

Maria Soriano-Reixach ◽

Izaskun Thomas-Arrizabalaga ◽

Jon A. Sistiaga-Suarez ◽

Jose A. González-García ◽

...

Keyword(s):

Head And Neck ◽

Neck Dissection ◽

Postoperative Period ◽

Surgical Complications ◽

Statistical Correlation ◽

University Hospital ◽

Common Complication ◽

Neck Malignancy ◽

Single Centre Study ◽

Functional Neck Dissection

Introduction: Functional neck dissection (FND) represents a surgical procedure usually associated with less morbidity. Methods: An observational, retrospective, analysis of patients diagnosed with any type of head and neck malignancy was designed to summarize and report the incidence of postoperative complications in patients undergoing FND including just those levels described for selective neck dissections in a tertiary university hospital between June 2016 and June 2019. Results: 131 patients met the inclusion criteria. The total number of sides studied was 200. 40.5% of the patients suffer a complication in the postoperative period, being the spinal accessory nerve (SAN) injury the most common complication (10%). We did not find any statistical correlation between the previous organ-preservation treatments and surgical complications (p = 0.207). An advanced T stage (p = 0.009) and the need of bilateral FND (p = 0.034) were significantly correlated with a higher risk of surgical complications. Conclusion: FND represents a useful technique. In this study, 40.5% of the patients suffer a complication in the postoperative period, being the SAN injury the most common complication. However, these data contribute to increasing our knowledge about surgical complications related to FND.

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Clinical features of pharyngeal cancer: a retrospective study of 258 consecutive patients

The Journal of Laryngology & Otology ◽

10.1258/0022215011907703 ◽

2001 ◽

Vol 115 (2) ◽

pp. 112-118 ◽

Cited By ~ 18

Author(s):

A. Escribano Uzcudun ◽

P. Bravo Fernández ◽

J. J. Sánchez ◽

A. García Grande ◽

I. Rabanal Retolaza ◽

...

Keyword(s):

Retrospective Study ◽

Head And Neck ◽

Clinical Features ◽

Medical Records ◽

Performance Status ◽

Nasopharyngeal Cancer ◽

University Hospital ◽

Premalignant Lesions ◽

Pharyngeal Cancer ◽

Presenting Symptoms

Pharyngeal cancer still presents an unsatisfactory mortality (30-40 per cent in most series, with a slightly better prognosis for nasopharyngeal cancer relative to both oropharyngeal and hypophyarngeal cancers) despite advances in treatment. Therefore, it is critical to know the clinical features of pharyngeal cancer. The purpose of this study was to investigate the most relevant clinical features of pharyngeal cancer (oropharyngeal, hypopharyngeal, and nasopharyngeal) in order to improve knowledge of this malignancy with the aim of ameliorating diagnosis and treatment.The retrospective study was based on a review of medical records from 258 consecutive patients with pharyngeal cancer (oropharyngeal, hypopharyngeal and nasopharyngeal) diagnosed at La Paz University Hospital, Madrid, Spain, between January 1 1991 and and December 31 1995. Medical records were provided by the Departments of Otorhinolaryngology, Head and Neck Surgery, Radiation Oncology, and Medical Oncology.All medical records were analysed for the following clinical variables: 1) incidence, 2) sociodemographics, 3) sites (oropharynx, hypopharynx, nasopharynx) and subsites, 4) clinical and histological staging, 5) pathlogy, 6) presenting symptoms, 7) time to diagnosis, 8) patients’ general performance status at diagnosis, 9) personal cancer history and synchronous head and neck tumours, 10) premalignant lesions, and 11) paediatric cases.Our most outstanding finding was the excessively long time that elapsed between first clinical manifestation appearance and conclusive diagnosis of pharyngeal cancer (4.7 months for pharynx, 4.5 for oropharynx, 4.4 for hypopharynx and 6.5 for nasopharynx cancers). It was found that nasopharyngeal cancer was quite different from both oropharyngeal and hypopharyngeal cancers with respect to its potential aetiology, risk factors and clinical presentation. In addition it has a better prognosis.

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Angiosarcoma of the maxillary sinus

The Journal of Laryngology & Otology ◽

10.1258/0022215001905634 ◽

2000 ◽

Vol 114 (5) ◽

pp. 381-384 ◽

Cited By ~ 10

Author(s):

George A. Velegrakis ◽

John G. Panayiotides ◽

Charalambos E. Skoulakis ◽

Chariton E. Papadakis ◽

Dimitrios G. Papadakis ◽

...

Keyword(s):

Endothelial Cells ◽

Head And Neck ◽

Maxillary Sinus ◽

Paranasal Sinuses ◽

Vascular Endothelial Cells ◽

External Irradiation ◽

Malignant Neoplasms ◽

Vascular Endothelial ◽

Neck Area ◽

Medial Maxillectomy

Angiosarcomas are rapidly growing malignant neoplasms arising from the vascular endothelial cells. Most common sites are the extremities and the retroperitoneal space, with only four per cent of angiosarcomas arising in the head and neck area, whilst the paranasal sinuses are one of the rarest locations. We report the case of a maxillary sinus angiosarcoma in a 72-year-old male patient. The first biopsy was inconclusive, whereas the second revealed an angiosarcoma. Medial maxillectomy was performed with subsequent external irradiation.

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