Ways and methods of closing tissue defects of the middle zone of the facial skull after removal of malignant tumors with intracranial spread (case from practice)
A clinical case of locally advanced basal cell skin cancer with bone destruction is presented. Patient Ya., born in 1936, was under the supervision of doctors for basal cell skin cancer since 1982 (for 38 years). She was hospitalized in the department of extracerebral tumors of Romodanov Institute of Neurosurgery NAMS of Ukraine 09.27.2019. Multispiral computer and magnetic resonance imaging were performed.
Considering the duration and spread of the tumor, the patient was offered an operation to remove the tumor within healthy tissue with resection of the auricle and parotidectomy. When receiving informed consent for surgical treatment, the patient put forward conditions regarding the scope of the operation: preservation of symmetry of the face, appearance of the face and integrity of the auricle. Surgery was performed, followed by symptomatic treatment. Reconstructive technologies for closing defects of the soft tissue of the facial skull were applied. She was operated on on October 4, 2019. The postoperative period was uneventful. Healing occurred by primary tension. The patient was discharged from the hospital in satisfactory condition on the 18th day (October 22, 2019). Postoperative distant gamma therapy was performed on the projection area of the primary focus and the predominant anatomical routes of lymph drainage (total focus dose ‒ 45 Gy). Catamnesis postoperative ‒ 13 months. After 37 years, a relapse occurred with the tumor process involving all branches of the facial nerve, bones of the skull, metastasis to regional lymph nodes. The treatment was carried out at the Romodanov Institute of Neurosurgery NAMS of Ukraine. The patient did not consent to the extended scope of the surgical intervention, setting the condition of preserving the appearance. In this regard, the removal of affected tissues was carried out along the edge of the tumor invasion (without a reserve of healthy tissues) while preserving the trunk and branches of the facial nerve, i.e. in violation of the generally recognized principles of ablastics.
The presented case of the course of the disease proves that timely radiation therapy at the first signs of a skin tumor contributes to a good clinical effect, which made it possible to achieve a long relapse-free period with a decent quality of life and full socialization. The progressive course of the disease (recurrence) justifies the feasibility of replacing large facial skull tissue defects after radical removal of parotid skin cancer with intracranial spread using the method of combining local plastic surgery and free skin flap transplantation, developed and implemented in the Department of Extracerebral Tumors.
Paches AI. Opuholi golovy i shei. Moskva; 2000. P. 41-59. (In Russian)
Shental’ VV, Pustynskij IN, Kirjushkina MS. Metastazy bazal’nokletochnogo raka kozhi oblasti golovy i shei. Moskva; 1993. P. 76-80. (In Russian)
Ismailov ZD. Recidivy i metastazy raka kozhi: Avtoref. dis. …kand. med. nauk. Tashkent; 1987. 24 p. (In Russian)
Shental’ VV, Tabolinovskaja TD, Pustynskij IN. Prakticheskaja kriohirurgija. Moskva; 1995. 302 p. (In Russian)
International Statistical Classification of Diseases and Related Health Problems 10th Revision [http://apps.who.int/classifications/icd10/browse/2016/en]
LeBoit PE, Burg G, Weedon D, Sarasin A (eds.). World Health Organisation classification of tumors. Pathology and Genetics of Skin Tumours. Lyon: IARCPress; 2006.
Kvasha MS, Morozov TA. Patent na korysnu model N 131199 vid 10.01.2019. Sposib plastychnogo zamishhennja defektiv shkiry seredn’oji liniji golovy chotyrma sumizhnymy symetrychnymy rotacijnymy klaptjamy. Bjul. #1. (In Ukrainian)
Bath-Hextall F, Bong J, Perkins W, Williams H. Interventions for basal cell carcinoma of the skin: systematic review. BMJ. 2004;329(7468):705. DOI: 10.1136/bmj.38219.515266.AE PMID: 15364703. PMCID: PMC518891
Brodland DG, Zitelli JA: Surgical margins for excision of primary cutaneous squamous cell carcinoma. J Am Acad Dermatol. 1992;27(2 Pt 1):241-8.
Bozan A, Gode S, Kaya I, et al. Long-term follow-up of positive surgical margins in basal cell carcinoma of the face. Dermatol Surg. 2015;41(7):761-7. DOI: 10.1016/0190-9622(92)70178-i PMID: 1430364
Sobin LH, Gospodarowicz MK, Wittekind C (eds.). The TNM classification of malignant tumours. 8th ed. Wiley-Blackwell; 2009. 310 p. ISBN: 9781444332414
Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR, Buzaid AC, Cochran AJ, Coit DG, Ding S, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27(36):6199-206. doi: 10.1200/JCO.2009.23.4799.
Schmults CD, Blitzblau R, Aasi SZ, et al. NCCN Guidelines® Insights: Squamous Cell Skin Cancer, Version 1.2022 // J Natl Compr Canc Netw. 2021 Dec;19(12):1382-94. doi: 10.6004/jnccn.2021.0059.
Bichakjian C, Olencki T, Aasi S, et al. Basal Cell Skin Cancer. Version 1.2016. NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2016 May;14(5):574-97. doi: 10.6004/jnccn.2016.0065.
This work is licensed under a Creative Commons Attribution 4.0 International License.