- Email: [email protected]
Treatment of nasal columellar tumours with radiotherapy – A good alternative to surgery?
Free poster abstracts numbered P1 - P255 / British Journal of Oral and Maxillofacial Surgery 54 (2016) e66–e153
P100 Non-flap non-graft healing of scalp defects following skin tumour resection Clare Schilling ∗ , Hana Kennedy, Ashraf Messiha Guys Hospital and St Georges Hospital, London Introduction: Post resection scalp defects can pose a difficult reconstructive dilemma, particularly in the frail patient. Multiple lesions, inflamed skin, radiotherapy, co-morbidty and medications can limit the choice of local and distant autogenous tissue transfer. We present our experience in using non-surgical methods for successful healing including large defects and exposed bone. Methods: We present a series of 30 patients in which the primary pathology was SCC in ten cases and BCC in the remainder. In 5patients previous reconstruction had failed to close the defect. The average scalp defect was 5.5 cm2 (Range 3-15). An algorhythmic approach to healing was undertaken and progress was recorded by clinical examination and photographs in a dedicated dressing clinic. Results: In 22 patients successful healing was managed by cleaning, Manuka honey (Medihoney) application +/anti inflammatory medication with average time to healing 3.8weeks. In 3patients granulation tissue was clearly seen to arise from islands within the calverial bone. In 8patients alloplastic dermal matrix (Integra) was used in additionally resulting in healing with acceptable cosmetic results in all patients by 5.2weeks. Discussion: Our results challenge the surgical dictum that epithelialisation will not occur on exposed bone. These findings are confirmed by recent reports in the medical literature. Although best cosmetic results are obtained by means of local flaps there will always be a number of patients in whom this is not an option and in these cases we believe healing can be obtained by non reconstructive methods. http://dx.doi.org/10.1016/j.bjoms.2016.11.101 P101 Adherence to recording the minimum data set in the histological reporting of facial basal cell carcinomas Sarah Ali ∗ , Gerard Gillan Oral, Maxillofacial, Head and Neck Surgery, Homerton University Hospital Introduction: The meticulous histological reporting and diagnosis has an important role in defining patient treatment. Datasets enable pathologists to grade and stage cancers consistently so that they are compliant with standards. Basal cell carcinomas (BCC) have a low mortality, but their morbidity levels can be high; adverse cosmetic effects can be distressing to patients. Comprehensive and accurate reporting allows clinicians to appropriately manage patients given their individual diagnoses.
e101
Methods: We retrospectively reviewed patients who had undergone excision of facial basal cell carcinomas over a 12month period. We gathered data using the electronic patient record system, and used the Royal College of Pathologists BCC dataset audit proforma to analyse the histology reports. Results: 27 patients were included in this sample. All reports had the correct clinical data such as site, type and the presence of a marker stitch. In looking at the macroscopic details (size of specimen and maximum diameter of the lesion), 26 reports had detailed this. On reviewing the microscopic details, there was a particular failure in recording the presence of perineural or lymphovascular spread. The peripheral and deep margins were omitted in 3 reports, and the risk status was only recorded in 8 reports. Clinical Relevance: Margins are essential on histology reporting in order to direct appropriate surgical treatment and reconstruction. All items on the minimum data set should be recorded. Discrepancies were noted in the terminology used by pathologists in comparison to conventional literature. Following feedback, a re-audit will be carried out prospectively. http://dx.doi.org/10.1016/j.bjoms.2016.11.102 P102 Treatment of nasal columellar tumours with radiotherapy – A good alternative to surgery? Nicola Mahon ∗ , Sally Al-Ali, Gary Walton Coventry University Hospital Introduction: Tumours of the nasal columella are a challenge to the reconstructive surgeon. Obtaining adequate resection margins and satisfactory cosmesis can often be a surgical impossibility. Radiotherapy is a treatment option to use as either an adjunct or alternative to surgery. Methods: This study was a 14 year retrospective analysis of patients who had radiotherapy for nasal columellar tumours. The aims of this study were to evaluate the recurrence rate, complications and patient satisfaction with their cosmetic appearance post radiotherapy. Results: Seventeen patients had radiotherapy for columellar tumours in Coventry University Hospital from 1992 – 2016. There were 8 males and 9 females whose ages ranged from 46yrs to 85yrs. Clinical notes were available for 15 patients. Histology consisted of 14 SCC’s and 1 adenocarcinoma. Six patients had both radiotherapy and surgery, 6had radiotherapy alone and 3had chemoradiotherapy. The most common radiotherapy course was 50GY in 15 fractions. In 5 out of 15 cases there was a recurrence of the tumour – recurrence rate 33%. However, in 2 of these cases the intention was palliative radiotherapy only due to the extent of the tumour. Complications included mucositis and pain, one patient had an epiphora secondary to obstruction of the nasolacrimal ducts as a result of radiotherapy. Only one patient was dissatisfied with their appearance post radiotherapy and requested reconstruction.
e102
Free poster abstracts numbered P1 - P255 / British Journal of Oral and Maxillofacial Surgery 54 (2016) e66–e153
Conclusion; Results from this study prove that radiotherapy is a valuable treatment for columellar tumours. Complication rates are low and 93% of patients are satisfied with their cosmetic result. http://dx.doi.org/10.1016/j.bjoms.2016.11.103 P103 Excision margins for lentigo maligna Edward Walker ∗ , Dean Palmer, Nausheen Siddiqui, Diane Patterson Royal Blackburn Hospital Introduction:Lentigo maligna is a melanoma-in-situ which typically develops on chronically sun damaged skin in older patients. The reported risk of progression to malignant melanoma is between 5% and 20%. Complete surgical excision with a 5 mm to 10 mm margin is the standard treatment for lentigo maligna (Hou et al., 2015). Aims:We aim to assess the adequacy of a predetermined 5 mm clinical excision margin for lentigo maligna with respect to complete excision and histological margin. Methods: Patients who have undergone excision of facial lentigo maligna with a predetermined 5 mm margin within our unit since 2011 are included in this ongoing audit. The data collection sheet documented patient demographics, surgical margin, and completeness of excision, histological margin and skin MDT recommendation. Results: Of the first 21 patients who have undergone excision of lentigo maligna, 20 were completely excised. The closest mean histological margin was 2.74 mm. Skin MDT recommended that 2 patients with completely excised lentigo maligna undergo further excision because the closest histological margin was less than 2 mm. Discussion: In our unit, excision of lentigo maligna with a predetermined 5 mm surgical margin resulted in an excision rate of 95%. There is a lack of evidence correlating histological margin and recurrence rate however Akhtar et al reported a recurrence rate of 1.4% with a histological margin less than 2 mm (Akhtar et al., 2014). The face is a cosmetically sensitive area which is challenging to reconstruct and this small ongoing audit suggests that wider excision is not necessary to achieve a safe histological margin. http://dx.doi.org/10.1016/j.bjoms.2016.11.104
P104 Galeal turnover flap: a technique for immediate reconstruction of full thickness scalp defects Anand Kumar ∗ , Richard Crosher Rotherham NHS Foundation Trust Introduction: The scalp is a common site for skin cancer, typically in older men. In these cases surgery often requires excision of the periosteum to ensure tumour clearance on the deep aspect. Areas of exposed bone can be difficult to reconstruct if the defect is too big to repair with local flaps. Split skin grafts can be applied to burred bone but healing tends to be poor. Delayed skin grafting with or without the use of a biomembrane needs two procedures. Negative pressure dressings are effective but depend on good patient compliance to succeed. More complex surgery, e.g. tissue expansion or free flap reconstruction might not be appropriate for this group of patients. Another option for larger full thickness defects is a galeal turnover flap with split skin grafting. This technique is described and the results of procedures performed over the last two years presented. Method: All patients who had a galeal turnover flap with skin grafting Feb 2014 – Feb 2016 were reviewed. Results: Six patients, 5 male, 1 female. Full thickness excisions were done for the following skin tumours: Squamous carcinoma 4; Atypical fibroxanthoma 1; Basal cell carcinoma 1. There was complete healing in four patients, partial (2/3) graft take in one and one complete graft failure. Clinical relevance: This technique is a one stage which can be done under local anaesthetic with acceptable outcomes and low morbidity. http://dx.doi.org/10.1016/j.bjoms.2016.11.105 P105 The lughole – How to deal with the external auditory meatus in skin cancer surgery Paul Davies ∗ , Spencer Hodges King’s College Hospital The incidence of skin cancer is increasing, due to an aging population and the increased exposure to ultraviolet radiation. It is estimated that up to one third of basal cell carcinomas arise on or near the ear. A significant percentage of squamous cell carcinomas arise on the pinna. We present a technique for reconstructing the external auditory meatus (EAM) in a patient with an extensive squamous cell carcinoma affecting the pinna. We also discuss the problems and solutions in treating skin cancers of the external ear which extend into EAM. Guidelines state that margins for squamous cell carcinoma (SCC) should be extended to at least 6 mm on the ear. When the EAM cartilage is transected and separated from the rest of the ear cartilage the pinna can become grossly distorted
P100 Non-flap non-graft healing of scalp defects following skin tumour resection Clare Schilling ∗ , Hana Kennedy, Ashraf Messiha Guys Hospital and St Georges Hospital, London Introduction: Post resection scalp defects can pose a difficult reconstructive dilemma, particularly in the frail patient. Multiple lesions, inflamed skin, radiotherapy, co-morbidty and medications can limit the choice of local and distant autogenous tissue transfer. We present our experience in using non-surgical methods for successful healing including large defects and exposed bone. Methods: We present a series of 30 patients in which the primary pathology was SCC in ten cases and BCC in the remainder. In 5patients previous reconstruction had failed to close the defect. The average scalp defect was 5.5 cm2 (Range 3-15). An algorhythmic approach to healing was undertaken and progress was recorded by clinical examination and photographs in a dedicated dressing clinic. Results: In 22 patients successful healing was managed by cleaning, Manuka honey (Medihoney) application +/anti inflammatory medication with average time to healing 3.8weeks. In 3patients granulation tissue was clearly seen to arise from islands within the calverial bone. In 8patients alloplastic dermal matrix (Integra) was used in additionally resulting in healing with acceptable cosmetic results in all patients by 5.2weeks. Discussion: Our results challenge the surgical dictum that epithelialisation will not occur on exposed bone. These findings are confirmed by recent reports in the medical literature. Although best cosmetic results are obtained by means of local flaps there will always be a number of patients in whom this is not an option and in these cases we believe healing can be obtained by non reconstructive methods. http://dx.doi.org/10.1016/j.bjoms.2016.11.101 P101 Adherence to recording the minimum data set in the histological reporting of facial basal cell carcinomas Sarah Ali ∗ , Gerard Gillan Oral, Maxillofacial, Head and Neck Surgery, Homerton University Hospital Introduction: The meticulous histological reporting and diagnosis has an important role in defining patient treatment. Datasets enable pathologists to grade and stage cancers consistently so that they are compliant with standards. Basal cell carcinomas (BCC) have a low mortality, but their morbidity levels can be high; adverse cosmetic effects can be distressing to patients. Comprehensive and accurate reporting allows clinicians to appropriately manage patients given their individual diagnoses.
e101
Methods: We retrospectively reviewed patients who had undergone excision of facial basal cell carcinomas over a 12month period. We gathered data using the electronic patient record system, and used the Royal College of Pathologists BCC dataset audit proforma to analyse the histology reports. Results: 27 patients were included in this sample. All reports had the correct clinical data such as site, type and the presence of a marker stitch. In looking at the macroscopic details (size of specimen and maximum diameter of the lesion), 26 reports had detailed this. On reviewing the microscopic details, there was a particular failure in recording the presence of perineural or lymphovascular spread. The peripheral and deep margins were omitted in 3 reports, and the risk status was only recorded in 8 reports. Clinical Relevance: Margins are essential on histology reporting in order to direct appropriate surgical treatment and reconstruction. All items on the minimum data set should be recorded. Discrepancies were noted in the terminology used by pathologists in comparison to conventional literature. Following feedback, a re-audit will be carried out prospectively. http://dx.doi.org/10.1016/j.bjoms.2016.11.102 P102 Treatment of nasal columellar tumours with radiotherapy – A good alternative to surgery? Nicola Mahon ∗ , Sally Al-Ali, Gary Walton Coventry University Hospital Introduction: Tumours of the nasal columella are a challenge to the reconstructive surgeon. Obtaining adequate resection margins and satisfactory cosmesis can often be a surgical impossibility. Radiotherapy is a treatment option to use as either an adjunct or alternative to surgery. Methods: This study was a 14 year retrospective analysis of patients who had radiotherapy for nasal columellar tumours. The aims of this study were to evaluate the recurrence rate, complications and patient satisfaction with their cosmetic appearance post radiotherapy. Results: Seventeen patients had radiotherapy for columellar tumours in Coventry University Hospital from 1992 – 2016. There were 8 males and 9 females whose ages ranged from 46yrs to 85yrs. Clinical notes were available for 15 patients. Histology consisted of 14 SCC’s and 1 adenocarcinoma. Six patients had both radiotherapy and surgery, 6had radiotherapy alone and 3had chemoradiotherapy. The most common radiotherapy course was 50GY in 15 fractions. In 5 out of 15 cases there was a recurrence of the tumour – recurrence rate 33%. However, in 2 of these cases the intention was palliative radiotherapy only due to the extent of the tumour. Complications included mucositis and pain, one patient had an epiphora secondary to obstruction of the nasolacrimal ducts as a result of radiotherapy. Only one patient was dissatisfied with their appearance post radiotherapy and requested reconstruction.
e102
Free poster abstracts numbered P1 - P255 / British Journal of Oral and Maxillofacial Surgery 54 (2016) e66–e153
Conclusion; Results from this study prove that radiotherapy is a valuable treatment for columellar tumours. Complication rates are low and 93% of patients are satisfied with their cosmetic result. http://dx.doi.org/10.1016/j.bjoms.2016.11.103 P103 Excision margins for lentigo maligna Edward Walker ∗ , Dean Palmer, Nausheen Siddiqui, Diane Patterson Royal Blackburn Hospital Introduction:Lentigo maligna is a melanoma-in-situ which typically develops on chronically sun damaged skin in older patients. The reported risk of progression to malignant melanoma is between 5% and 20%. Complete surgical excision with a 5 mm to 10 mm margin is the standard treatment for lentigo maligna (Hou et al., 2015). Aims:We aim to assess the adequacy of a predetermined 5 mm clinical excision margin for lentigo maligna with respect to complete excision and histological margin. Methods: Patients who have undergone excision of facial lentigo maligna with a predetermined 5 mm margin within our unit since 2011 are included in this ongoing audit. The data collection sheet documented patient demographics, surgical margin, and completeness of excision, histological margin and skin MDT recommendation. Results: Of the first 21 patients who have undergone excision of lentigo maligna, 20 were completely excised. The closest mean histological margin was 2.74 mm. Skin MDT recommended that 2 patients with completely excised lentigo maligna undergo further excision because the closest histological margin was less than 2 mm. Discussion: In our unit, excision of lentigo maligna with a predetermined 5 mm surgical margin resulted in an excision rate of 95%. There is a lack of evidence correlating histological margin and recurrence rate however Akhtar et al reported a recurrence rate of 1.4% with a histological margin less than 2 mm (Akhtar et al., 2014). The face is a cosmetically sensitive area which is challenging to reconstruct and this small ongoing audit suggests that wider excision is not necessary to achieve a safe histological margin. http://dx.doi.org/10.1016/j.bjoms.2016.11.104
P104 Galeal turnover flap: a technique for immediate reconstruction of full thickness scalp defects Anand Kumar ∗ , Richard Crosher Rotherham NHS Foundation Trust Introduction: The scalp is a common site for skin cancer, typically in older men. In these cases surgery often requires excision of the periosteum to ensure tumour clearance on the deep aspect. Areas of exposed bone can be difficult to reconstruct if the defect is too big to repair with local flaps. Split skin grafts can be applied to burred bone but healing tends to be poor. Delayed skin grafting with or without the use of a biomembrane needs two procedures. Negative pressure dressings are effective but depend on good patient compliance to succeed. More complex surgery, e.g. tissue expansion or free flap reconstruction might not be appropriate for this group of patients. Another option for larger full thickness defects is a galeal turnover flap with split skin grafting. This technique is described and the results of procedures performed over the last two years presented. Method: All patients who had a galeal turnover flap with skin grafting Feb 2014 – Feb 2016 were reviewed. Results: Six patients, 5 male, 1 female. Full thickness excisions were done for the following skin tumours: Squamous carcinoma 4; Atypical fibroxanthoma 1; Basal cell carcinoma 1. There was complete healing in four patients, partial (2/3) graft take in one and one complete graft failure. Clinical relevance: This technique is a one stage which can be done under local anaesthetic with acceptable outcomes and low morbidity. http://dx.doi.org/10.1016/j.bjoms.2016.11.105 P105 The lughole – How to deal with the external auditory meatus in skin cancer surgery Paul Davies ∗ , Spencer Hodges King’s College Hospital The incidence of skin cancer is increasing, due to an aging population and the increased exposure to ultraviolet radiation. It is estimated that up to one third of basal cell carcinomas arise on or near the ear. A significant percentage of squamous cell carcinomas arise on the pinna. We present a technique for reconstructing the external auditory meatus (EAM) in a patient with an extensive squamous cell carcinoma affecting the pinna. We also discuss the problems and solutions in treating skin cancers of the external ear which extend into EAM. Guidelines state that margins for squamous cell carcinoma (SCC) should be extended to at least 6 mm on the ear. When the EAM cartilage is transected and separated from the rest of the ear cartilage the pinna can become grossly distorted