Tijjani Umar

Cutaneous head and neck SCCs and risk of nodal metastasis – UK experience

AIM To identify the risk of developing metastases to regional nodes in patients with cutaneous squamous cell carcinomas (CSCCs) of the head and neck. METHODS A retrospective study of patients with CSCC treated with surgical excision alone between 2000 and 2002 was performed. Demographic details of the patients, the site, size, differentiation, depth of invasion, clearance of surgical margins, and the presence of perineural or lymphovascular invasion of the lesion were documented. During the follow up period, patients with regional metastases were identified. The site of the metastasis and the time after the primary resection were documented and statistical analysis was performed using Chi-square and logistic regression analysis. RESULTS One hundered and ninety-four patients were included and 218 CSCCs were excised in total during the period of 3 years. The scalp was the most common site of skin lesion, followed by the ear. The incidence of regional metastatic disease was found to be 5.15%. The parotid gland was the most common area of regional metastasis. No metastases occurred after the first 2 years of follow up. The pinna, the poor differentiation and incomplete excision margins were found to be associated with regional metastasis independently, with odds ratio of 16, 21, and 2 respectively. CONCLUSIONS The rate of regional metastasis from CSCC remains low. The parotid gland was the most favoured metastatic site. Patients with poorly differentiated squamous cell carcinoma (SCC) located on the ear and incomplete excision margins were at the greatest risk for developing regional lymph node metastasis and require close follow up.

Expression of vascular endothelial growth factor in basal cell carcinoma and cutaneous squamous cell carcinoma of the head and neck.

Background:  Basal cell carcinomas (BCC) and squamous cell carcinomas (SCC) can both arise from any cutaneous epithelial surface. BCC are slow growing and rarely metastasise, whereas SCC are usually more aggressive. It is likely that the angiogenic process plays a key role in determining rate of growth and propensity for dissemination. Angiogenesis is a complex process requiring many factors and a pivotal group of proteins involved in this process is vascular endothelial growth factor (VEGF).

Head and neck pilomatricoma: an analysis of 201 cases

We report our experience with 201 pilomatricomas of the head and neck. They occurred over a wide age range (2-93 years, mean 29.5) and were most common in the first and second decades. Almost half (49%) presented in people over 40 years of age and there was no sex predilection (male:female ratio 1:1.1). The most common presentation was as a slowly enlarging, asymptomatic, subcutaneous mass, although nearly 25% were symptomatic, and 12% had a reddish blue skin discolouration. Most lesions were solitary; only 9 patients (5%) had multiple lesions. The most commonly affected sites were the cheek (23%), neck (22%), eyebrow (18%), and scalp (14%). Tumours were often mistaken for other lesions and a correct preoperative diagnosis was made in only 28% of cases. Preoperative investigations were done only occasionally and were not always helpful. All lesions were excised and excision was reported to have been incomplete in 22%. Two patients (1%) had a recurrence after incomplete excision. We highlight the condition to raise awareness among clinicians, and we support conservative excision as the most appropriate method of treatment.