Teli Mohmad Ashraf, Khan N A, Darzi M Ashraf, Gupta Meenu, Tufail A
Department of Radiation Oncology, SKIMS, Soura, Srinagar - 190 011, Kashmir, India.
Indian J Dermatol. 2009;54(4):342-6. doi: 10.4103/0019-5154.57610.
The spectrum of skin cancer in Kashmir valley is drastically different from the rest of the country. Maxwell was the first to report skin cancer of lower extremities in Kashmiri population, developing on/over erythema ab igne, and attributed it to the use/or exposure of Kangri. These tumors have an aggressive biological behavior with a substantial risk of loco-regional metastasis in 30-50% cases. Because of unique geographical distribution of Kangri cancer, there is dearth of literature regarding the natural history, loco-regional and distant metastatic pattern and treatment recommendations in these tumors.
To study the metastatic pattern of these skin tumors and to assess the impact of various treatment modalities and use of prophylactic nodal treatment in this clinical entity.
The retrospective study (study period 1993-2005) included 266 patients of squamous cell carcinoma of skin of lower extremities and abdominal wall. Two hundred and forty-four cases with a follow-up of 2-7 years were included for final analysis with stress on loco-regional relapse pattern and methods of treatment evolved and used at our institute from time to time. Statistical analysis was done using yates corrected Chi-square test and odds ratio analysis.
Our results favor the use of post operative radiotherapy to primary and prophylactic treatment of regional nodes on the lines of head and neck tumors in these cases.
Post operative radiotherapy significantly decreases the loco-regional recurrences and a trial of prophylactic nodal irradiation is justified in a selected group of such patients.
克什米尔山谷地区皮肤癌的种类与该国其他地区截然不同。麦克斯韦是首个报道克什米尔人群下肢皮肤癌的人，该癌症在火激红斑上或其上方发生，并将其归因于使用或接触汤婆子。这些肿瘤具有侵袭性生物学行为，在30%至50%的病例中有较高的局部区域转移风险。由于汤婆子癌独特的地理分布，关于这些肿瘤的自然病史、局部区域和远处转移模式以及治疗建议的文献匮乏。
研究这些皮肤肿瘤的转移模式，并评估各种治疗方式以及预防性淋巴结治疗在这一临床实体中的影响。
这项回顾性研究（研究时间段为1993年至2005年）纳入了266例下肢和腹壁皮肤鳞状细胞癌患者。对244例随访2至7年的病例进行最终分析，重点关注局部区域复发模式以及我们研究所不时采用和发展的治疗方法。使用耶茨校正卡方检验和比值比分析进行统计分析。
我们的结果支持在这些病例中对原发灶采用术后放疗以及对区域淋巴结采用类似头颈部肿瘤的预防性治疗。
术后放疗可显著降低局部区域复发率，对选定的这类患者进行预防性淋巴结照射试验是合理的。
