Osguthorpe J D, Abel C G, Lang P, Hochman M
Department of Otolaryngology, Medical University of South Carolina, Charleston, USA.
Arch Otolaryngol Head Neck Surg. 1997 Aug;123(8):871-6. doi: 10.1001/archotol.1997.01900080105013.
To determine the outcomes of patients with neurotropic cutaneous tumors of the head and neck.
A retrospective review was conducted of 7852 charts of patients who underwent micrographically controlled excisions of skin cancers of the head and neck between 1984 and 1995, identifying neurotropic tumors and the outcomes of their treatments.
Tertiary care center (university hospital).
Thirty-seven patients with neurotropic tumors were identified (and confirmed by secondary histological review), constituting 0.47% of all patients. The median age at presentation was 68 years and all except an albino were white. Nine patients had basal cell carcinomas and 28 had squamous cell carcinomas. Twenty-five patients (69%) were referred after at least 1 prior excision was performed a median of 16 months previously.
All patients underwent micrographic mapping and excision of the cutaneous portion of the tumor. As necessitated by tumor spread, additional soft tissue, skull base, and/or intracranial surgery and postoperative irradiation were also conducted.
Thirty-four patients (3 patients were unavailable for follow-up) were assessed by physician examination a minimum of 19 months after treatment (median, 33 months).
Of 25 patients with extracranial disease only, 19 had no evidence of disease during follow-up and 1 died of intercurrent disease at 20 months without evidence of tumor persistence. Of the 9 patients with intracranial neurotropic tumors at the time of presentation, 1 remained with no evidence of disease, 1 died of intercurrent disease at 21 months without evidence of tumor persistence, and the other 7 either died of or are living with an intracranial tumor.
Micrographic tissue mapping to detect and then encompass neurotropic cutaneous malignancies, along with conventional surgery for deeper tumor invasions and irradiation in selected cases, was successful in 19 patients (76%) with an extracranial tumor. For those with neurotropic tumors approaching or penetrating the skull base, the prognosis was poor regardless of therapy method.
确定头颈部神经性皮肤肿瘤患者的治疗结果。
对1984年至1995年间接受头颈部皮肤癌显微控制切除术的7852例患者的病历进行回顾性研究，识别神经性肿瘤及其治疗结果。
三级医疗中心（大学医院）。
共识别出37例神经性肿瘤患者（经二次组织学检查确诊），占所有患者的0.47%。就诊时的中位年龄为68岁，除1例白化病患者外均为白人。9例为基底细胞癌，28例为鳞状细胞癌。25例患者（69%）在至少1次先前切除术后（中位时间为16个月）被转诊。
所有患者均接受肿瘤皮肤部分的显微绘图和切除术。根据肿瘤扩散情况，必要时还进行额外的软组织、颅底和/或颅内手术以及术后放疗。
34例患者（3例无法进行随访）在治疗后至少19个月（中位时间为33个月）接受医生检查。
仅25例有颅外疾病的患者中，19例在随访期间无疾病证据，1例在20个月时死于并发疾病，无肿瘤持续存在的证据。9例就诊时患有颅内神经性肿瘤的患者中，1例仍无疾病证据，1例在21个月时死于并发疾病，无肿瘤持续存在的证据，其他7例死于颅内肿瘤或仍患有颅内肿瘤。
显微组织绘图以检测并切除神经性皮肤恶性肿瘤，以及对深部肿瘤侵犯进行传统手术并在特定病例中进行放疗，在19例（76%）颅外肿瘤患者中取得了成功。对于那些神经性肿瘤接近或穿透颅底的患者，无论采用何种治疗方法，预后都很差。
