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Surgical management of scalp squamous cell carcinoma: predictive value of tumour thickness and deep marginal clearance for regional recurrence
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21st ICOMS 2013 - Abstracts: Oral Papers
T32.OR010
T32.OR012
Surgical management of scalp squamous cell carcinoma: predictive value of tumour thickness and deep marginal clearance for regional recurrence
Topical imiquimod for severe recurrent keloid management – a clinical experience A. Ujam ∗ , S. Bashir, N. Baksh, C. Huppa, K. Fan
A. Pinto 1,∗ , P. Raphy 1 , C. Jones 1 , S.A. Parikh 1 , A. Mahdmina 1 , B. Elwazani 1 , M.W. Ho 2 Kings College Hospital, United Kingdom 1 Wirral
University Teaching Hospital, Arrowe Park, UK 2 Aintree University Hospitals NHS Foundation Trust, Liverpool, UK Background and objectives: Early detection and good loco-regional control is essential for success in surgical management of cutaneous malignancy. In the scalp, the ability to achieve adequate deep marginal clearance can sometimes offer a challenge due to local anatomy (scalp–calvarium junction). This becomes more relevant with increased tumour thickness/depth of invasion. Methods: Retrospective review of medical records: 115 consecutive patients with histological diagnosis of scalp squamous cell carcinoma who were treated with primary surgery from 2005 to 2012. Data collection: patient demography, surgical pathology, reconstruction of defects, regional recurrence and follow-up duration. Results (main findings): Median age 80.7 years (IQR 76-85.4). Gender distribution: 102 (89%) male and 13 (11%) female. Median follow-up 23.5 months (IQR 8.2-42.3). Overall regional recurrence rate in this cohort was 4.3% (5/115). Forty-six patients (40%) required local flaps and 63 (55%) had skin grafts, to reconstruct the ablative surgical defects. In six patients (5%), the wounds were closed primarily. Tumour differentiation*: 29 well (28%), 56 moderate (55%) and 17 poor (17%). Tumour thickness*: <4 mm in 20 (33%) patients and >4 mm in 41 (67%) patients; regional recurrence 10% (4/41) vs 0. Deep margin*: <1 mm in 33 (30%) patients and >1 mm in 76 (70%) patients; regional recurrence rates 12% (4/33) vs 0.01% (1/76). *only patients with completed dataset included. Conclusions: The overall regional recurrence rate in this cohort was within the 5% risk generally accepted for cutaneous head and neck malignancy. The risk factors identified for development of regional parotid/neck recurrence include tumour thickness >4 mm and deep marginal clearance <1 mm. This high risk group of patients should be selected to undergo more intensive follow-up programme by means of ultrasound surveillance. Although the role of sentinel node biopsy is still unproven, this should be a consideration in the context of a clinical trial. Key words: scalp cancer; skin cancer; squamous cell carcinoma Conflict of interest: None declared.
Background: Managing difficult hypertrophic scars and keloids can be challenging. Current concepts in the treatment of such lesions is variable and extensive. Topical Imiquimod, an immunomodulator, obtained FDA approval in 1997 and has been used successfully for treating a variety of skin pathologies ranging from squamous cell carcinomas to condylomata of the skin. We report on a case series of 9 patients with severe recurrent keloid scars (ranging from 3 cm to 30 cm) that underwent surgery followed by application of topical imiquimod to prevent recurrence. Methods: 9 patients with persistent recurrent keloid scar to the head and neck region underwent routine surgical excision, injection of triamcinolone to the wound edges followed by healing by secondary intention. From day 2 topical Imiquimod was applied to the wound edges 3 times per week until the wound had completely healed. Results: Patients were examined post-operatively at regular intervals and signs of recurrence were recorded. Complications and local skin reactions were noted. Only 1 patient developed a recurrence 5 months post-operatively. None of the patients developed toxicity, 2 patients returned to hospital due to bleeding. Pain was troublesome in 2 patients and 1 patient developed hyper pigmentation of the scar. An Itchy scar was another reported side effect in a few patients. Conclusion: Topical Imiquimod appears to be a safe and effective treatment modality for the management of extensive recurrent keloid. Our case series provides evidence to support the use of topical Imiquimod although larger studies are needed. http://dx.doi.org/10.1016/j.ijom.2013.07.651 T32.OR013 Squamous cell carcinoma induce phenotypic and genomic changes in macrophages F.Q. Wang ∗ , G. Chen, W. Zhang, Y.F. Zhao School & Hospital of Stomatology, Wuhan University, China
http://dx.doi.org/10.1016/j.ijom.2013.07.649 T32.OR011 Sentinel node biopsy in patients with head and neck Merkel Cell Carcinoma: a retrospective study A.S. Ricard ∗ , Q. Sessiecq, F. Siberchicot, C. Majoufre-Lefebvre, M. Laurentjoye Service De Chirurgie Maxillofaciale, Chu Pellegrin, 33076 Bordeaux, France Merkel Cell Carcinoma is a cutaneous neuroendocrine neoplasm with propensity for lymphatic spread. Sentinel node biopsy enables the identification of occult nodal metastases. At our institution, we are increasingly utilizing SLNB to patients who present with stage I/II Merkel Cell Carcinoma since 2008. In this retrospective study, we aimed to report the rate of positive SLNB and to assess the impact of SLNB for the management of patients with MCC. Patients and methods: A total of 12 patients with Stage I or II patients Merkel Cell carcinoma of head and neck who had undergone SLNB were identified over a 4-year period. Results: Of 12 patients, 1 had a positive SN biopsy. Sentinel node biopsy was not identified in 1 patient. Of the remaining 10 patients who had a negative SN biopsy, 2 had regional lymph node recurrence. During the follow-up period, no patient died. Conclusion: Merkel Cell Carcinoma is an uncommon but highly aggressive skin malignancy and management protocols have been based mainly on the results of small studies. The role of SLNB in the management of Merkel Cell carcinoma remains to be defined.
Background and objectives: Tumour associated inflammation is a major driving force in the progression of squamous cell carcinoma (SCC), the most common caner in head and neck. The aim of the present study is to investigate that whether SCC cells could affected the inflammatory environment by interaction with monocytes. Methods: Monocytes (THP-1) stained with PKH26 were exposed to SCC cells (CAL-27) and adenoid cystic carcinoma (ACC) cells (SACC-83), followed by FACS analyses and detection of monocyte-to-marcophage differentiation, polarization, attachment and gene expression by real time PCR. Changes induced by co-culture were compared with that observed under classical differentiation and polarization conditions. Immunohistochemical staining was performed to evaluate the expression level of CD68 in SCC and ACC tissues (as a control for non-inflammatory tumour). Results: In vitro studies revealed that THP-1 cells co-cultured with CAL-27 had more significantly altered gene expression with up-regulation of both M1 and M2 macrophage markers (IL-1alpha, IL-6, TNF-alpha, and MMP-9), than that co-cultured with SACC-83. Compared to SACC-83, CAL-27 induced more THP-1 cells to attach and differentiate into macrophages. THP-1 that co-cultured with CAL-27 expressed higher levels of CXCR4 than with SACC-83. Moreover, more extensive chemokine SDF-1alpha was detected in the co-cultured CAL-27 rather than SACC-83 cells. The co-culture system containing AMD3100 significantly suppressed THP-1 cells attachment and differentiation. The immunohistochemical results revealed that much more expression of CD68+ macrophages in SCC tissues than that in ACC. Conclusions: Compared to non-inflammatory cancer, SCC, as an inflammatory tumour, showed enhanced abilities in recruiting and inducing differentiation of monocytes, which indicated that inflammation in such tumours may be the nature of itself rather than induced by external factors. Key words: inflammation; cancer; macrophages; co-culture; SDF-1alpha
http://dx.doi.org/10.1016/j.ijom.2013.07.650 http://dx.doi.org/10.1016/j.ijom.2013.07.652
21st ICOMS 2013 - Abstracts: Oral Papers
T32.OR010
T32.OR012
Surgical management of scalp squamous cell carcinoma: predictive value of tumour thickness and deep marginal clearance for regional recurrence
Topical imiquimod for severe recurrent keloid management – a clinical experience A. Ujam ∗ , S. Bashir, N. Baksh, C. Huppa, K. Fan
A. Pinto 1,∗ , P. Raphy 1 , C. Jones 1 , S.A. Parikh 1 , A. Mahdmina 1 , B. Elwazani 1 , M.W. Ho 2 Kings College Hospital, United Kingdom 1 Wirral
University Teaching Hospital, Arrowe Park, UK 2 Aintree University Hospitals NHS Foundation Trust, Liverpool, UK Background and objectives: Early detection and good loco-regional control is essential for success in surgical management of cutaneous malignancy. In the scalp, the ability to achieve adequate deep marginal clearance can sometimes offer a challenge due to local anatomy (scalp–calvarium junction). This becomes more relevant with increased tumour thickness/depth of invasion. Methods: Retrospective review of medical records: 115 consecutive patients with histological diagnosis of scalp squamous cell carcinoma who were treated with primary surgery from 2005 to 2012. Data collection: patient demography, surgical pathology, reconstruction of defects, regional recurrence and follow-up duration. Results (main findings): Median age 80.7 years (IQR 76-85.4). Gender distribution: 102 (89%) male and 13 (11%) female. Median follow-up 23.5 months (IQR 8.2-42.3). Overall regional recurrence rate in this cohort was 4.3% (5/115). Forty-six patients (40%) required local flaps and 63 (55%) had skin grafts, to reconstruct the ablative surgical defects. In six patients (5%), the wounds were closed primarily. Tumour differentiation*: 29 well (28%), 56 moderate (55%) and 17 poor (17%). Tumour thickness*: <4 mm in 20 (33%) patients and >4 mm in 41 (67%) patients; regional recurrence 10% (4/41) vs 0. Deep margin*: <1 mm in 33 (30%) patients and >1 mm in 76 (70%) patients; regional recurrence rates 12% (4/33) vs 0.01% (1/76). *only patients with completed dataset included. Conclusions: The overall regional recurrence rate in this cohort was within the 5% risk generally accepted for cutaneous head and neck malignancy. The risk factors identified for development of regional parotid/neck recurrence include tumour thickness >4 mm and deep marginal clearance <1 mm. This high risk group of patients should be selected to undergo more intensive follow-up programme by means of ultrasound surveillance. Although the role of sentinel node biopsy is still unproven, this should be a consideration in the context of a clinical trial. Key words: scalp cancer; skin cancer; squamous cell carcinoma Conflict of interest: None declared.
Background: Managing difficult hypertrophic scars and keloids can be challenging. Current concepts in the treatment of such lesions is variable and extensive. Topical Imiquimod, an immunomodulator, obtained FDA approval in 1997 and has been used successfully for treating a variety of skin pathologies ranging from squamous cell carcinomas to condylomata of the skin. We report on a case series of 9 patients with severe recurrent keloid scars (ranging from 3 cm to 30 cm) that underwent surgery followed by application of topical imiquimod to prevent recurrence. Methods: 9 patients with persistent recurrent keloid scar to the head and neck region underwent routine surgical excision, injection of triamcinolone to the wound edges followed by healing by secondary intention. From day 2 topical Imiquimod was applied to the wound edges 3 times per week until the wound had completely healed. Results: Patients were examined post-operatively at regular intervals and signs of recurrence were recorded. Complications and local skin reactions were noted. Only 1 patient developed a recurrence 5 months post-operatively. None of the patients developed toxicity, 2 patients returned to hospital due to bleeding. Pain was troublesome in 2 patients and 1 patient developed hyper pigmentation of the scar. An Itchy scar was another reported side effect in a few patients. Conclusion: Topical Imiquimod appears to be a safe and effective treatment modality for the management of extensive recurrent keloid. Our case series provides evidence to support the use of topical Imiquimod although larger studies are needed. http://dx.doi.org/10.1016/j.ijom.2013.07.651 T32.OR013 Squamous cell carcinoma induce phenotypic and genomic changes in macrophages F.Q. Wang ∗ , G. Chen, W. Zhang, Y.F. Zhao School & Hospital of Stomatology, Wuhan University, China
http://dx.doi.org/10.1016/j.ijom.2013.07.649 T32.OR011 Sentinel node biopsy in patients with head and neck Merkel Cell Carcinoma: a retrospective study A.S. Ricard ∗ , Q. Sessiecq, F. Siberchicot, C. Majoufre-Lefebvre, M. Laurentjoye Service De Chirurgie Maxillofaciale, Chu Pellegrin, 33076 Bordeaux, France Merkel Cell Carcinoma is a cutaneous neuroendocrine neoplasm with propensity for lymphatic spread. Sentinel node biopsy enables the identification of occult nodal metastases. At our institution, we are increasingly utilizing SLNB to patients who present with stage I/II Merkel Cell Carcinoma since 2008. In this retrospective study, we aimed to report the rate of positive SLNB and to assess the impact of SLNB for the management of patients with MCC. Patients and methods: A total of 12 patients with Stage I or II patients Merkel Cell carcinoma of head and neck who had undergone SLNB were identified over a 4-year period. Results: Of 12 patients, 1 had a positive SN biopsy. Sentinel node biopsy was not identified in 1 patient. Of the remaining 10 patients who had a negative SN biopsy, 2 had regional lymph node recurrence. During the follow-up period, no patient died. Conclusion: Merkel Cell Carcinoma is an uncommon but highly aggressive skin malignancy and management protocols have been based mainly on the results of small studies. The role of SLNB in the management of Merkel Cell carcinoma remains to be defined.
Background and objectives: Tumour associated inflammation is a major driving force in the progression of squamous cell carcinoma (SCC), the most common caner in head and neck. The aim of the present study is to investigate that whether SCC cells could affected the inflammatory environment by interaction with monocytes. Methods: Monocytes (THP-1) stained with PKH26 were exposed to SCC cells (CAL-27) and adenoid cystic carcinoma (ACC) cells (SACC-83), followed by FACS analyses and detection of monocyte-to-marcophage differentiation, polarization, attachment and gene expression by real time PCR. Changes induced by co-culture were compared with that observed under classical differentiation and polarization conditions. Immunohistochemical staining was performed to evaluate the expression level of CD68 in SCC and ACC tissues (as a control for non-inflammatory tumour). Results: In vitro studies revealed that THP-1 cells co-cultured with CAL-27 had more significantly altered gene expression with up-regulation of both M1 and M2 macrophage markers (IL-1alpha, IL-6, TNF-alpha, and MMP-9), than that co-cultured with SACC-83. Compared to SACC-83, CAL-27 induced more THP-1 cells to attach and differentiate into macrophages. THP-1 that co-cultured with CAL-27 expressed higher levels of CXCR4 than with SACC-83. Moreover, more extensive chemokine SDF-1alpha was detected in the co-cultured CAL-27 rather than SACC-83 cells. The co-culture system containing AMD3100 significantly suppressed THP-1 cells attachment and differentiation. The immunohistochemical results revealed that much more expression of CD68+ macrophages in SCC tissues than that in ACC. Conclusions: Compared to non-inflammatory cancer, SCC, as an inflammatory tumour, showed enhanced abilities in recruiting and inducing differentiation of monocytes, which indicated that inflammation in such tumours may be the nature of itself rather than induced by external factors. Key words: inflammation; cancer; macrophages; co-culture; SDF-1alpha
http://dx.doi.org/10.1016/j.ijom.2013.07.650 http://dx.doi.org/10.1016/j.ijom.2013.07.652