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PubMed2000

Serial excision of a large facial skin cancer.

BACKGROUND: In the management of large facial neoplasms, the dermatologic surgeon must consider local factors affecting the success of closures. OBJECTIVE: Large facial neoplasms can be removed serially with Mohs micrographic surgery. Serial excision facilitates recruitment of adjacent normal skin for replacement of lesional skin, minimizing the risks of necrosis. METHODS: A large morpheaform basal cell carcinoma was excised serially. The initial defect was closed with an O to L advancement flap. The final excision and repair 2 months later consisted of a combination of primary closure with marsupialization and pursestring closure. A full-thickness skin graft was used to close the final defect. RESULTS: The patient had optimal cosmesis at 2-year follow-up. CONCLUSION: Large facial neoplasms can be excised serially. This technique, performed in the setting of Mohs micrographic surgery, takes advantage of "mechanical and biologic creep," resulting in excellent cosmesis and function.

Aged↗
PubMed1988

Facial paralysis: traumatic neuromas vs. facial nerve neoplasms.

Traumatic neuromas (TN) are benign proliferations of neural tissue that may occur without disruption of the facial nerve. The clinical presentation, as well as the radiographic appearance, may suggest neoplastic involvement of the facial nerve. Histologically, they may closely resemble neurilemomas (Schwannomas) or neurofibromas. Three cases of TN of the facial nerve associated with facial paralysis are presented here. Unlike previously reported cases, these tumors were not associated with chronic inflammatory middle ear disease. TN must be considered in the differential diagnosis and treatment of facial paralysis.

Adolescent↗
PubMedDate not supplied

[Ultrasonography and surgical treatment of facial skin neoplasms].

In the second half of the 20 century, echosonography has been used in many medical specialities. In 1992 and 1993 highfrequencies echosonography was used in the examination of irritant and allergic skin lesions in order to examine the effects of different therapeutical agents on the skin lesions [1-4]. Hoffmann used highfrequencies echosonography in the examination of healing of skin lesions [3]. By their incidence skin tumours are the largest group of newly discovered tumours, and their usual location is on the face [5-7]. By clinical examination it is not possible to precisely determine the depth of tumour border; therefore, the radically performed surgical excision is the only correct surgical treatment. The aim of this study was to estimate the results of preoperatively performed high frequencies echosonography in order to reduce the number of incorrectly performed surgical excisions of skin tumours. The group was composed of 40 patients with 45 tumours, who first underwent echosonographic diagnostic procedure (20 MHz, Hadsund electronic, Hadsund Technology, Denmark) and then surgical excision; patients in control group (45 patients with 45 tumours) were only subjected to surgical excision. Excised tumours were then pathohistologically analyzed, and measurements of tumour depth progression were performed. Margins of pathohistological specimen were controlled for the presence of tumour cells. Results of measurements of tumour depth obtained by echosonography and pathohistological measurements were compared. By Jate's modification of c2 test results regarding correct and incorrect surgical excision in patients and control group were compared. By linear regression analysis results of tumour depth obtained by echosonographic and pathohistologic examinations were compared. Hypoechogen zone echosonographic results were used like criteria for tumour expansion. Results of tumour depth measurements are presented in Table 1. Linear regression analysis showed (R = 0.64) that echosonographic examination gave objective pictures of tumour depth. Six specimens were excluded from this examination, and only the presence of tumour cells on specimen margins were analysed. All tumours in patients were excised radically; in control group tumour cells were present on pathohistological specimens margins of six cases. In comparison p = 0.5016 was a not significant value. Success of 100% of specimens correctly excised in operated patients is the success which is very close to success of Moh's micrographic surgery (by Fleming only 1% of tumour relapse in a five-year follow-up period) [8]. Result of 13.33% of incorrect excision in control group is close to results obtained by Leshin and al [9]. Result of p = 0.05016 is not statistically significant, but is very close to statistically significant values. This might require future examinations in a larger group of patients. Results of R = 0.64 correlate with results obtained by Hoffmann [3], because they show that highfrequencies ultrasound examination gives an objective picture of skin tumours depth. Results of this examination show that preoperative highfrequencies ultrasound examination can determine the progression of tumour depth, and give to surgeon data which can help him to perform correct surgical excisions.

Basal Cell Carcinoma↗
PubMed1995

[Photodynamic diagnosis and therapy of neoplasms of the facial skin after topical administration of 5-aminolevulinic acid].

Topical application of 5-aminolevulinic acid (5-ALA) is a useful instrument for photodynamic diagnosis and therapy of skin tumours. Diagnostic fluorescence imaging after laser light irradiation (410 nm) revealed a high, tumour-specific fluorescence even in tumour areas not apparent prior to this examination technique. This demonstrates the possibility of photodynamic diagnosis to detect skin tumours. In the therapeutic group 8 patients with 6 solar keratoses and 12 basal cell carcinomas underwent laser light irradiation using a wavelength of 635 nm (dosage 100 J/cm2) 6 hours after topical application of 5-ALA in W/O emulsion. 2-12 hours after laser application we observed reddened tumour tissue with mild oedema, subsequently followed by a crust and epithelised within 4-6 weeks. 2 months after PDT a complete response was observed for all solar keratoses and for 10 of 12 basal cell carcinomas. Photodynamic therapy following topical application of 5-ALA may be an alternative treatment modality for skin tumours.

Administration, Topical↗
PubMed1986

[Radiotherapy of neoplasms of the facial skin].

Radiotherapy--predominantly with soft x-rays--is, besides plastic surgery and cryosurgery, suitable for the treatment of facial malignancies for which operation would be undesirable in consideration of tumour size and the patient's general health, age and internal diseases. Operation should be preferred for smaller tumours that can be operated on with primary wound closure; tumours that grow into the mouth angle or into the cartilaginous folds of the ear; for patients under 50 years of age; for facial malignancies that have already caused a defect; for patients with nevoid basal cell epithelioma syndrome or xeroderma pigmentosum; for melanomas and sarcomas (except lentigo maligna). Optimal results are achieved by exact limitation of the irradiated area (with a safety margin) and a ray hardness that corresponds to the individual tumour thickness. Due to mechanical irritation, unusually high sun exposure, allergies, pyodermas and local treatment with corticosteroids ulceration may develop in the radioderma remaining after radiotherapy. Radiation-induced tumours occurring in radiodermas are extremely rare if irradiation was applied for a facial malignancy according to the rules and after the 50th year of age.

Aged↗