Micrographic surgey for the treatment of non-melanoma skin cancers of the head and neck

El�in, Gonca; �zer, Serdar; G�k�z, �zay; Y�cel, �mer Ta�k�n; �zaygen, G�l Erkin; Akan, T�lin

Micrographic surgey for the treatment of non-melanoma skin cancers of the head and neck [Turkderm-Turk Arch Dermatol Venereol]

Turkderm-Turk Arch Dermatol Venereol. 2016; 50(1): 2-9 | DOI: 10.4274/turkderm.23334

Micrographic surgey for the treatment of non-melanoma skin cancers of the head and neck

Gonca El�in¹, Serdar �zer², �zay G�k�z³, �mer Ta�k�n Y�cel², G�l Erkin �zaygen⁴, T�lin Akan⁴
¹Hacettepe �niversitesi T�p Fak�ltesi Deri ve Z�hrevi Hastal�klar Anabilim Dal�
²Hacettepe �niversitesi T�p Fak�ltesi Kulak Burun Bo�az Hastal�klar� Anabilim Dal�
³Hacettepe �niversitesi T�p Fak�ltesi T�bbi Patoloji Anabilim Dal�
⁴Emekli ��retim �yesi, Hacettepe �niversitesi T�p Fak�ltesi, Deri ve Z�hrevi Hastal�klar Anabilim Dal�, Ankara, T�rkiye

Background and Design: Micrographic surgery is an intraoperative microscope-controlled surgery which aims at the excision of the entire tumor by achieving 100% control of the surgical margins with horizontal sectioning. In micrographic surgery, the healthy skin is preserved maximally due to the stepwise excision of the tumor using narrow margins. Due to its highest cure rates and maximal tissue preserving properties, it is the treatment of choice for high-risk non-melanoma skin cancers. Micrographic surgery is not routinely included in the dermatologic surgical procedures in Turkey. The aim of this study was to provide the availability of micrographic surgery for selected patients.
Materials and Methods: During 2010-2015, 116 non-melanoma skin cancers that belong to 102 patients (53 male, 49 female) were treated with micrographic surgery. All tumors were located on the head or neck, and exhibiting at least one high-risk factor for recurrence. Micrographic surgery was performed with the Munich method between 2010 and 2013, and with Mohs surgery between 2013 and 2015.
Results: The mean age of patients was 65.86�12.33 years (range: 33-90 years). The localization of the tumors was the head (n=112) and the neck (n=4). The number of micrographic surgery sessions to eliminate the tumor was 1 session for 55 (47.41%), 2 sessions for 55, and more than 2 sessions for 8 (6.89%) of the tumors. Six of the defects were left for secondary intention healing, 31 were repaired primarily and 13 defects were repaired with full thickness skin grafts whereas 66 were repaired with flaps.
Conclusion: The results of this study showed that microscopic eradication of non-melanoma skin cancer necessitates more than one session for more than half of the cases, illuminating that microscopic extension of non-melanoma skin cancer beyond clinically apparent tumor is very likely. The results support that for tumors located on the head and neck where healthy skin should be preserved maximally for functional and cosmetic reasons, the use of micrographic surgery is a necessity.

Keywords: Mohs surgery, basal cell carcinoma, squamous cell carcinoma, dermatologic surgical procedures, skin neoplasms

Ba� ve boyun yerle�imli melanom d�� deri kanserlerinin tedavisinde mikrografik cerrahi

Ama�: Mikrografik cerrahi intraoperatif olarak mikroskop kontrol�nde uygulanan ve horizontal kesitlerle %100 s�n�r kontrol� sa�layarak t�m�r�n tamam�n�n ��kar�lmas�n� hedefleyen bir cerrahi y�ntemdir. Mikrografik cerrahide t�m�r dar g�venlik s�n�rlar� kullan�larak kademeli ��kar�ld�� i�in sa�lam doku en y�ksek oranda korunur. Y�ntem k�r oranlar�n�n y�ksekli�i ve doku koruyuculu�u nedeniyle y�ksek riskli melanom d�� deri kanserlerinde tedavi se�ene�i olarak �nerilmektedir. �lkemizde dermatolojik cerrahi uygulamalar aras�nda mikrografik cerrahi rutin olarak yer almamaktad�r. Bu �al��man�n amac� mikrografik cerrahi y�nteminin se�ilmi� hastalar i�in uygulanabilmesini sa�lamakt�.
Gere� ve Y�ntem: 2010-2015 tarihleri aras�nda 102 hastaya ait (53 erkek ve 49 kad�n), 116 melanom d�� deri kanseri (113 bazal h�creli karsinom ve 3 skuam�z h�creli karsinom) mikrografik cerrahi ile tedavi edildi. T�m�rlerin t�m� ba� veya boyunda lokalize idi ve rek�rrens a��s�ndan en az 1 y�ksek risk fakt�r� ta��yordu. Mikrografik cerrahi 2010-2013 y�llar� aras�nda M�nih metoduyla, 2013-2015 y�llar� aras�nda ise Mohs cerrahisi kullan�larak uyguland�.
Bulgular: Hastalar�n ya� ortalamas� 65,86�12,33, aral�� 33-90 ya� idi. T�m�rlerin 112�si ba�a yerle�irken, 4�� ise boyun yerle�imli idi. T�m�rs�z s�n�ra ula�mak i�in uygulanan mikrografik cerrahi kademe say�s� 55 (%47,41) t�m�r i�in 1 kademe, 55 t�m�r i�in 2 kademe iken 8 (%6,89) t�m�r i�in 2 kademeden fazla olarak ger�ekle�ti. Defektlerden 6�s� sekonder yara iyile�mesine b�rak�l�rken, 31�i primer olarak onar�ld�, 13 defekte tam kat deri grefti uygulan�rken, 66 defekt ise flep ile onar�ld�.
Sonu�: Bu �al��ma ile mikrografik cerrahi T�rkiye�de 5 y�l s�reyle aral�ks�z uygulanm��t�r. Bu �al��man�n sonu�lar� mikroskobik eradikasyonun t�m�rlerin yar�s�ndan fazlas�nda birden fazla mikrografik cerrahi kademesi gerektirdi�ini dolay�s�yla melanom d�� deri kanserlerinin klinikte g�zle g�r�nenin �tesinde yay�lma e�ilimi oldu�unu g�stermektedir. Sonu�lar fonksiyonel ve kozmetik a��dan sa�lam derinin korunmas�n�n kritik �neme sahip oldu�u ba� ve boyun yerle�imli t�m�rlerde mikrografik cerrahinin uygulanmas� gereklili�ini desteklemektedir.

Anahtar Kelimeler: Mohs cerrahisi, bazal h�creli karsinom, skuam�z h�creli karsinom, dermatolojik cerrahi giri�imler, deri kanserleri

Gonca El�in, Serdar �zer, �zay G�k�z, �mer Ta�k�n Y�cel, G�l Erkin �zaygen, T�lin Akan. Micrographic surgey for the treatment of non-melanoma skin cancers of the head and neck. Turkderm-Turk Arch Dermatol Venereol. 2016; 50(1): 2-9

Corresponding Author: Gonca El�in, T�rkiye

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