Tissue conservation in treatment of cutaneous neoplasms of the head and neck. Combined use of Mohs' chemosurgical and conventional surgical techniques.

Abstract

• Skin cancer is the most common cancer and can usually be treated successfully through surgical excision, radiation therapy, electrical desiccation, curettage, and Mohs' chemosurgery. However, there are a considerable number of these lesions that involve or encroach on head and neck structures vital to function and cosmesis. These lesions are challenging and frustrating to the physician who tries to achieve a cure while preserving tissue integrity. Mohs' chemosurgery alone has long been accepted as a means of improving cure in recurrent or large basal cell carcinomas by virtue of total microscopic control of margins. This method has been employed in conjunction with conventional excision to improve cure rates and preserve tissue in difficult basal cell carcinomas of the head and neck. We have utilized this interdisciplinary approach in the most challenging areas of skin cancer: the medial canthus with globe preservation, the columella and nasal tip with ala preservation, and the premaxilla and columella with upper lip preservation. With this team approach, there can be great accuracy in the amount of tissue removed. Areas where tumor has extended can be accurately identified and removed with chemosurgical or conventional surgical techniques. In addition, crucial functionally and cosmetically important tissue is preserved without compromise. ( Arch Otolaryngol 105:140-144, 1979)