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Related Experiment Videos

Microscopically oriented histologic surgery for head and neck mucosal cancer.

T M Davidson1, P Haghighi, R Astarita

  • 1Department of Head & Neck Surgery, University of California, San Diego.

Cancer
|October 15, 1987
PubMed
Summary

MOHS surgery effectively resects head and neck epidermoid tumors by tracing microscopic extensions. This study challenges "field cancerization" and highlights limitations of standard margin analysis for detecting thin tumor projections.

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Area of Science:

  • Oncology
  • Head and Neck Surgery
  • Dermatopathology

Background:

  • Epidermoid tumors of the head and neck present challenges in complete surgical resection due to potential microscopic extensions beyond clinically apparent disease.
  • Understanding tumor spread patterns is crucial for optimizing surgical strategies and improving patient outcomes in head and neck cancer.

Purpose of the Study:

  • To evaluate the efficacy of Mohs, micrographic surgery in the resection of primary epidermoid tumors of the head and neck.
  • To analyze the patterns of tumor spread and assess the adequacy of conventional surgical margin assessment.
  • To determine the local control rates and long-term outcomes following Mohs surgery for these tumors.

Main Methods:

  • Retrospective review of 93 cases of primary epidermoid tumors of the head and neck treated with Mohs surgery.

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  • Detailed analysis of tumor extension patterns, including submucosal spread and microscopic infiltration.
  • Assessment of local tumor control rates at 2-year follow-up, including salvage rates for recurrences.

    • Main Results:

    • Microscopic tumor extensions were identified up to 1 cm beyond clinically evident disease in 70% of cases.
    • Tumor spread predominantly occurred along submucosal planes, necessitating microscopically directed excisions.
    • High rates of local control (91%) were achieved with Mohs surgery, increasing to 95% with salvage of recurrences.

    Conclusions:

    • Epidermoid cancer of the head and neck exhibits continuous growth patterns, questioning the 'field cancerization' theory for local recurrence.
    • Mohs surgery is effective in tracing and removing microscopic tumor extensions, leading to high local control rates.
    • Conventional frozen section analysis of surgical margins is insufficient for detecting thin, finger-like tumor projections, underscoring the value of margin-guided techniques like Mohs surgery.