Neck dissection for N-positive disease must sacrifice involved structures as needed to eradicate the disease, even if that sometimes means facial nerves, said Dr. Bradford. Patient counseling should cover this possibility, as well as the potential need to do a mastoidectomy or resection of the lateral temporal bone. Immediate facial reanimation and soft tissue reconstruction should be considered, she said.
Explore this issue:November 2013
Randal Weber, MD, FACS, chair of head and neck surgery at The University of Texas at MD Anderson Cancer Center in Houston, said surgery alone is usually adequate for early-stage skin cancer without aggressive features. But radiation therapy should be considered when there are positive margins or tumors larger than 4 cm with deep invasion, perineural invasion and lymph node metastasis.
POST (Post-Operative Skin Trial), an Australian trial, is looking at radiation alone versus radiation and chemotherapy in high-risk squamous cell patients, and Dr. Weber said he’s eagerly anticipating the results. “Look out for this study,” Dr. Weber said. “I think it’ll answer an important question, if we should intensify treatment for these very-high risk patients.”
Researchers at MD Anderson are also looking at the effectiveness of gefitinib in aggressive cutaneous squamous cell carcinoma cases. The drug, used in lung cancer patients for whom chemotherapy has failed, inhibits the activity of epithelial growth factor receptor, which is highly expressed in the skin. In a phase II study, patients were given the drug before standard therapy with surgery and/or radiation therapy. Three of 22 evaluable patients had a complete response, seven had a partial response and five were stable, Dr. Weber said. (Clin Cancer Res. 2012;18:1435-1446).
No biological basis has been found yet for the responders but studies are continuing. Dr. Weber said it might be a look at future treatments. “It’s pretty remarkable to think you can take one pill a day and get this sort of response from a skin cancer, especially an aggressive one.”