Follow-up care is also an integral aspect of care. Although lymph node metastasis at the time of presentation is less than 20%, subsequent relapse does occur and if not detected early and aggressively managed, the patient’s chances for disease control and cure are dramatically diminished. These patients require close observation by the multidisciplinary team members, not only by their primary physician or general dermatologist, who may be unfamiliar with signs, symptoms, and patterns of relapse.
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July 2007In summary, it is not whether Mohs surgery is more or less effective than conventional resection; the key is that the therapeutic approach should be tailored to the biologic behavior of the disease. For patients with cutaneous basal cell carcinoma and nonaggressive squamous carcinoma of the head and neck, Mohs micrographic surgery with careful tumor mapping and complete resection will achieve three desired goals: (1) cost-effective eradication of the tumor in an outpatient setting, (2) conservation of involved tissue, and (3) immediate reconstruction. In contrast, patients with aggressive squamous cell carcinomas require multidisciplinary management with the surgeon following oncologic principles of en bloc resection and wide tumor-free margins as determined by frozen section or analysis of fixed tissue. Appropriate use of adjuvant radiation therapy will enhance local-regional control and may improve survival. An experienced reconstructive surgeon will provide the patient with the optimum repair for restoration of form and function. Careful follow-up by the treatment team will facilitate rehabilitation, detect early recurrences, and permit effective salvage. Providing these patients with the most effective and comprehensive management will in the long run prove to be the most efficacious and cost-effective.
Reference
- Clayman GL, Lee JJ, Holsinger FC, et al. Mortality risk from squamous cell skin cancer. J Clin Oncol 2005;23(4):759-65.
©2007 The Triological Society
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