Poster
# 105
Poster |
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6th Internet World Congress for Biomedical Sciences |
Alejandro Nogueira(1), Teresa Pérez (2), MŞ Jesús Martínez González(3), Francisco Iglesias(4), Angel Perez Arias(5), Olatz Alcelay(6)
(1)(2)(3)(4)(5)(6)Hospital Central de Asturias - Oviedo. Spain
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[Dermatology] |
[Oral & Maxilofacial Surgery] |
[Plastic Surgery] |
Malignant lip tumour are 15% of all head and neck skin neoplasies. They come from the junction of the vermilion border with the skin. Recent figures indicate an improve cure rate that can be attribued to increased awareness, aerlier diagnosis and/or better treatment. The treatment ought to be individualised (1,2,3).
We have reviewed 152 patients over 10-years-period, presenting malignant lip tumours, 25 have been detached for presenting imcomplete documents and 23 hadn´t histologic confirmation; so we have studied 106 tumours (104) patients bigger than 1 cm, with histologic confirmation, operated under general anaesthesia. fig.1,fig.2.
There is male predominance 68% (graphic 1) with a mean age of 69 years (graphic 2); some risk factors have been found; tobacco 43%, UV_ radiation 29% (graphic 3). Most common location is the lower lip 79% (graphic 4) and almost all patients presented one lesion. All ofthe tumours are prymari lesions presented for years (mean 1 year and 6 months), 67% are smaller than 2 cm, and only 3% are bigger than 5 cm. Only 20% present palpable regional lymph nodes at the moment of diagnosis.
The first reconstructive surgery is made over a month after the diagnosis. At the moment of the surgery 76% of the tumours infiltrate the total lip thickness and 5% go through local structures. The surgery consist in: vermiliomectomy 17%, wedge excision 38% and wide excision 45% followed by a reconstructive procedure. Therapeutic functional lymph node dissection was made on 20% and prophylactic on 40%. The reconstructive procedure changes depending the localisation, size and depth of the lesion and defect: 40 local advanced flap , 20 V-Y mucous flap, 10 Webster unilateral flap and 7 bilateral,2 check bilateral flap, 6 Karapandzic unilateral and 5 bilateral, 1 nasolabial + mucous flap, 3 transposition flaps, 2 semialar advanced flap, 3 Abbe.Eastlander, 4 nasolabial flap 2 V-y flap and 1 local flap.fig.3,fig.4.
Most common histologic diagnosis was squamous cell carcinoma 84%, localised all of them at lower lip. Basal cell carcinomas were found at upper lip.
10% of patients received radiotherapy treatment after surgery. The overall recurrence rate is 22% (19 tumours recurrent once, 2 twice and 2 three times) mainly at lower lip over 13 months after surgery (graphic 5). The treatment changes, at first recurrence radiotherapy is given at 3 patients, surgical wide excision is made at all of them and reconstructive procedures used are more complex: 5 bilateral Karapandzic, 9 Webster flaps, 1 check falp, 1 paraescapular free flap and 1 pectoral muscle-cutaneous + Karapandzic flap. Bilateral lymph node dissection was made in 10 cases. At second recurrence the treatment consisted in radiotherapy, wide excision and reconstruction with paraescapular free flap on both cases, and at third recurrence palliative radiotherapy is given as treatment.
The basal cell is more common in female at upper lip, squamous cell in males at lower lip (graphic 6), 98% of smokers have squamous cells carcinomas at lower lip; 78% ofv sun exposed patients present squamous cells carcinomas.
After treatmen5t 81% of patients showed any level of microstomy and 10% were exitus.
Results reveal prognosis is relationed with the original tumour size, location, local recurrence, histology and presence of cervical metastasis (2).
Aggressive surgical treatment is recommended, prophylactic suprahyoid neck dissection, and radical neck dissection with cervical metastasis are presented.
The squamous cell lip carcinoma is more aggressive than the basal ones. The patients who have big, invasive lesion, with malignant histologic pattern and recurrent are benaficiated with a prophylactic suprahyoid neck dissection. The radiotherapy is less effective than the surgery in patients with lymph node disease. The loco-regional flaps are the reconstructive procedure with better functional and aesthetic outcome. The lymph nodes uncontrolled disease produces the exitus in this patients.
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[Dermatology] |
[Oral & Maxilofacial Surgery] |
[Plastic Surgery] |
