Cutaneous carcinoma of the head and neck: management of massive and previously uncontrolled lesions.

Cutaneous basal cell and squamous cell carcinoma is the most common of malignant neoplasms. The etiology and natural history of these cutaneous neoplasms are related to actinic exposure, age, sex, hereditary factors, previous tissue injury, and chemical ingestion and exposure. Identification of cutaneous basal cell and squamous cell carcinoma is important. There are several different histologic subtypes of basal cell carcinoma, and each behaves clinically in a different way. There are several accepted methods of treatment including cryosurgery, electrodesiccation and curettage, radiotherapy, surgical excision and Mohs' histographic surgery. Each of these methods is reviewed. The vast majority of cutaneous basal cell and squamous cell carcinomas are easily cured no matter what the treatment modality. However, about 10% of these tumors (30,000 new cases each year) are not cured. These tumors often become massive and uncontrollable. Sixty patients met the criteria of being massive and/or uncontrollable. These criteria are 1. size 3 cms or greater, 2. involvement deeper than skin and subcutaneous fat, 3. four or more previous treatments without control, or 4. proven metastatic disease. These patients with massive and/or uncontrollable tumors underwent treatment with either Mohs' histographic surgery followed by conventional surgery with total microscopic marginal control or conventional excision with total microscopic marginal control. Of the 60 patients treated in this way, 53 are free of disease; 41 of these patients have been free of disease for more than 24 months. Massive and/or previously uncontrollable tumors appear to be better controlled with total microscopic marginal control while preserving as much normal tissue as possible. This technique appears to allow preservation of important esthetic and functional tissue while excising the complete tumor with the greatest degree of certainty.