Haas E
Laryngol Rhinol Otol (Stuttg). 1982 Nov;61(11):611-7.
The complete mastery of reconstructive plastic surgery is a basic requirement essential for sufficient radical treatment of basal cell carcinoma in the facial area. Furthermore, the subclinical growth of the basal cell carcinoma must be taken into consideration. One can assume that the growth of the b.c.c. is much greater than the apparent clinical limits, especially in cases of recurrent tumours, tumours of long standing, tumours in frontal and temporal regions, as well as tumours with diameters of more than 2 cm and scleroderma growth. In such cases a safety margin of 8-15 mm is required, whereas in primary and locally well-defined b.c.c. a safety margin of 3-5 mm is regarded as sufficient. Following the examination of the microscopically controlled surgery developed by Mohs, which is suitable for improvement of the five-year cure rate after surgical treatment of b.c.c., the treatment of the squamous cell carcinoma of the bottom lip is dealt with. Taking into account the tendency of these tumours to metastasize, it is advised to carry out an elective neck-dissection confined to the suprahyoidal region in case of large squamous cell carcinoma and also in suspicious metastatic changes in the lymph nodes. The diagnosis of a malignant melanoma is fundamentally histological: The tumour is electrically excised with a clearance safety margin of surrounding skin of 0.5-1 cm if clinically there appears to be a 10% likelihood of the tumour being a malignant melanoma. If the histological frozen section of the excised tumour confirms the suspected diagnosis, in cases of high-risk melanomas an area of not less than 3 cm from the edge of the primary tumour must be reexcised. A free skin graft is preferred to cover the defect rather than a plastic repair by a pedicle-flap graft. The elective lymph node dissection in the case of malignant melanoma stage I is made dependent on the level of invasion and on the thickness of the tumour. Low-risk melanomas are operated on locally only whereas an elective dissection of the regional lymph nodes is generally recommended in cases of high-risk melanomas.
对面部基底细胞癌进行充分的根治性治疗，完全掌握整形重建外科技术是一项基本要求。此外，必须考虑基底细胞癌的亚临床生长情况。可以认为，基底细胞癌的生长范围远大于明显的临床边界，特别是在复发性肿瘤、长期存在的肿瘤、额颞部肿瘤以及直径超过2 cm和呈硬皮病样生长的肿瘤病例中。在这种情况下，需要8 - 15 mm的安全切缘，而对于原发性且局部边界清晰的基底细胞癌，3 - 5 mm的安全切缘被认为是足够的。在研究了适合提高基底细胞癌手术治疗后五年治愈率的莫氏显微控制手术之后，接下来讨论下唇鳞状细胞癌的治疗。考虑到这些肿瘤有转移的倾向，对于大的鳞状细胞癌以及淋巴结有可疑转移变化的情况，建议进行仅限于舌骨上区的选择性颈清扫术。恶性黑色素瘤的诊断基本上依靠组织学检查：如果临床上肿瘤有10%的可能性为恶性黑色素瘤，则用电切术切除肿瘤，并在周围皮肤保留0.5 - 1 cm的切缘安全边界。如果切除肿瘤的组织学冰冻切片证实了疑似诊断，对于高危黑色素瘤病例，必须从原发肿瘤边缘向外至少3 cm的区域再次切除。覆盖缺损时首选游离皮片移植，而不是带蒂皮瓣移植进行整形修复。I期恶性黑色素瘤的选择性淋巴结清扫术取决于浸润深度和肿瘤厚度。低危黑色素瘤仅进行局部手术，而高危黑色素瘤病例一般建议进行区域淋巴结的选择性清扫术。
