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Involved excision margins in cutaneous head and neck basal cell carcinomas and the outcomes of re-excisions
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Abstracts / British Journal of Oral and Maxillofacial Surgery 53 (2015) e37–e110
deem concerning. In the treatment of BCCs, 70% were aware of the optimal excision margin but 80% failed to include ‘recurrence’ or ‘incomplete excision’ when consenting patients. Teaching produced a significant improvement in scores across all topics. Conclusion: There is a definite need for inclusion of skin cancer teaching in induction training for dentally qualified SHOs to standardise baseline knowledge. http://dx.doi.org/10.1016/j.bjoms.2015.08.064 P 57 Outcomes in head and neck cutaneous tumours following complex surgical intervention and reconstruction A. Pai ∗ , J.R. Srinivasan Macclesfield District General Hospital, United Kingdom Aims: There is an estimated increase of incidence of skin cancer of about 3%–8% per year since 1960. This is a retrospective study conducted to identify if there was a similar increase in the number of patients presenting with advanced disease requiring complex resection and reconstruction in the head and neck region and outcomes following surgical treatment. Methods: The study was conducted in plastic surgery unit at Royal Preston hospital, a tertiary referral centre for head and neck cancer treatment in the region. We collected data from patients with skin cancer in the head and neck region and underwent following procedures: Lymphadenectomy, free and or pedicled flaps and parotidectomy during the period February 2005 to May 2011. Outcomes were analysed for complications, loco-regional control and survival. Results: Thirty-five patients with skin cancer: Squamous cell carcinoma (22/35), Malignant Melanoma (10/35), Basal Cell Carcinoma (2/35) and merkel cell (1/35) were included. Majority of these cases were recurrent disease (68.6%, 24/35). Highest number of cases were treated in the year 2010 (34.2%, 12/35), complications were seen in 37% (13/35) and residual disease in 54.2% (19/35). Mean disease specific survival was 27 months and overall survival, 18 months. Conclusion: A significant number of advance stage skin cancers are presenting to the plastic surgery department and with incidence rising, we could expect more complex cases. We also found that majority of our patients were successfully discharged from the hospital despite the complexity of surgery in this elderly patient group with multiple comorbidities. http://dx.doi.org/10.1016/j.bjoms.2015.08.065
P 58 Involved excision margins in cutaneous head and neck basal cell carcinomas and the outcomes of re-excisions A. Pinto ∗ , S. El-Basyuni, M. Boyle Aintree University Hospital, United Kingdom Introduction: The incomplete excision rate for cutaneous basal cell carcinomas (BCCs) is reported as high as 7%. Studies have reported recurrence rates as high as 41% for incompletely excised cutaneous BCCs. The current evidence supports re-excision of incompletely excised lesions. We thus audited the BCC pathology results at the Aintree University Hospital to ascertain our involved excision margin rates and subsequent outcomes for these cases. Methods: A trust approved retrospective audit was conducted, data was collected from the online electronic notes system and pathology database for the period 1999–2010. Only cases treated by the department of maxillofacial surgery were included. Results: 730 cases were identified of which 32 (4.38%) were incompletely excised. Of these, 25 (78.13%) had involved peripheral margins and 12 (37.50%) had involved deep margins. The nose with 15 cases (46.88%) was the subsite with the highest incomplete excision rate and here there were 33.3% higher involved peripheral than deep margins. 31 out of 32 cases were further excised of which 14 (45.16%) cases showed residual disease. 3 cases continued to have involved peripheral margins following re-excision. Of these 3 only 1 had a macroscopic local recurrence at 2 years with a 5 year follow-up. Conclusion: Our study specifically looks at head and neck subsites and is the first to identify the nose as a high risk site for involved peripheral margins. We strongly advise that macroscopic excision margins specifically on the nose are carefully measured rather than estimated to prevent further morbidity to patients. http://dx.doi.org/10.1016/j.bjoms.2015.08.066 P 59 Outcomes for atypical fibroxanthomas of the head and neck: a two centre study A. Pinto ∗ , V. Laxmi, C. Murphy, S. El Basyuni, C. Jones Aintree University Hospital, United Kingdom Introduction: Atypical fibroxanthomas (AFXs) are rare cutaneous malignancies. We conducted a study to assess our management outcomes for these lesions in the head and neck. Method: A retrospective study. Inclusion criteria; patients treated over 10 years with a diagnosis of AFX of the head and neck. Patients were treated at two hospitals in the Mersey region. Results: 39 patients met inclusion criteria. There was a male predilection; 37 males and 2 females. The average age
Abstracts / British Journal of Oral and Maxillofacial Surgery 53 (2015) e37–e110
deem concerning. In the treatment of BCCs, 70% were aware of the optimal excision margin but 80% failed to include ‘recurrence’ or ‘incomplete excision’ when consenting patients. Teaching produced a significant improvement in scores across all topics. Conclusion: There is a definite need for inclusion of skin cancer teaching in induction training for dentally qualified SHOs to standardise baseline knowledge. http://dx.doi.org/10.1016/j.bjoms.2015.08.064 P 57 Outcomes in head and neck cutaneous tumours following complex surgical intervention and reconstruction A. Pai ∗ , J.R. Srinivasan Macclesfield District General Hospital, United Kingdom Aims: There is an estimated increase of incidence of skin cancer of about 3%–8% per year since 1960. This is a retrospective study conducted to identify if there was a similar increase in the number of patients presenting with advanced disease requiring complex resection and reconstruction in the head and neck region and outcomes following surgical treatment. Methods: The study was conducted in plastic surgery unit at Royal Preston hospital, a tertiary referral centre for head and neck cancer treatment in the region. We collected data from patients with skin cancer in the head and neck region and underwent following procedures: Lymphadenectomy, free and or pedicled flaps and parotidectomy during the period February 2005 to May 2011. Outcomes were analysed for complications, loco-regional control and survival. Results: Thirty-five patients with skin cancer: Squamous cell carcinoma (22/35), Malignant Melanoma (10/35), Basal Cell Carcinoma (2/35) and merkel cell (1/35) were included. Majority of these cases were recurrent disease (68.6%, 24/35). Highest number of cases were treated in the year 2010 (34.2%, 12/35), complications were seen in 37% (13/35) and residual disease in 54.2% (19/35). Mean disease specific survival was 27 months and overall survival, 18 months. Conclusion: A significant number of advance stage skin cancers are presenting to the plastic surgery department and with incidence rising, we could expect more complex cases. We also found that majority of our patients were successfully discharged from the hospital despite the complexity of surgery in this elderly patient group with multiple comorbidities. http://dx.doi.org/10.1016/j.bjoms.2015.08.065
P 58 Involved excision margins in cutaneous head and neck basal cell carcinomas and the outcomes of re-excisions A. Pinto ∗ , S. El-Basyuni, M. Boyle Aintree University Hospital, United Kingdom Introduction: The incomplete excision rate for cutaneous basal cell carcinomas (BCCs) is reported as high as 7%. Studies have reported recurrence rates as high as 41% for incompletely excised cutaneous BCCs. The current evidence supports re-excision of incompletely excised lesions. We thus audited the BCC pathology results at the Aintree University Hospital to ascertain our involved excision margin rates and subsequent outcomes for these cases. Methods: A trust approved retrospective audit was conducted, data was collected from the online electronic notes system and pathology database for the period 1999–2010. Only cases treated by the department of maxillofacial surgery were included. Results: 730 cases were identified of which 32 (4.38%) were incompletely excised. Of these, 25 (78.13%) had involved peripheral margins and 12 (37.50%) had involved deep margins. The nose with 15 cases (46.88%) was the subsite with the highest incomplete excision rate and here there were 33.3% higher involved peripheral than deep margins. 31 out of 32 cases were further excised of which 14 (45.16%) cases showed residual disease. 3 cases continued to have involved peripheral margins following re-excision. Of these 3 only 1 had a macroscopic local recurrence at 2 years with a 5 year follow-up. Conclusion: Our study specifically looks at head and neck subsites and is the first to identify the nose as a high risk site for involved peripheral margins. We strongly advise that macroscopic excision margins specifically on the nose are carefully measured rather than estimated to prevent further morbidity to patients. http://dx.doi.org/10.1016/j.bjoms.2015.08.066 P 59 Outcomes for atypical fibroxanthomas of the head and neck: a two centre study A. Pinto ∗ , V. Laxmi, C. Murphy, S. El Basyuni, C. Jones Aintree University Hospital, United Kingdom Introduction: Atypical fibroxanthomas (AFXs) are rare cutaneous malignancies. We conducted a study to assess our management outcomes for these lesions in the head and neck. Method: A retrospective study. Inclusion criteria; patients treated over 10 years with a diagnosis of AFX of the head and neck. Patients were treated at two hospitals in the Mersey region. Results: 39 patients met inclusion criteria. There was a male predilection; 37 males and 2 females. The average age