[Mandibular osteoradionecrosis (ORN) as a side effect of head and neck cancer treatment: Factors that induce it]. / Osteoradionecrosis (ORN) mandibular como efecto colateral del tratamiento del cáncer de cabeza y cuello: factores que la inducen.

INTRODUCTION: Osteoradionecrosis of the mandible is a relatively common complication in patients with head and neck cancer undergoing radiotherapy or concomitant chemoradiotherapy, characterized by exposure of the mandibular bone either in the mouth or in the facial skin, with no improvement with conservative treatment for six months. The risk factors are radiotherapy in head and neck region, lack of dental prophylaxis before treatment and dental extraction. MATERIAL AND METHODS: Retrospective observational study analyzing incidence and etiologic factors of osteoradionecrosis in 250 patients undergoing radiotherapy or combined treatment of cervicofacial area between 2002 and 2010. RESULTS: 25 patients were included; the horizontal branch was the most affected area, followed by the anterior arch. Associated factors were: stage (T4a and T4b), tumor location (oral cavity), dental extraction pre or post-radiotherapy, and radiotherapy time (pre-or postoperative); 72% had association with tooth extraction. Only five patients had control with conservative measures, and 20 required some type of mandibulectomy, only three of them were candidates for reconstruction with fibular free flap; none received treatment in a hyperbaric chamber. CONCLUSIONS: The data suggest that osteoradionecrosis has a multifactorial origin, and prevention is the best alternative and includes pretreatment dental prophylaxis to avoid tooth extractions and close monitoring and surveillance in order to identify early osteoradionecrosis. Most patients require mandible resection as definitive treatment.

[Clinical characteristics of malignant tumours originating in the external ear]. / Características clínicas de los tumores malignos originados en el pabellón auricular.

BACKGROUND: Skin tumours that originate in the external ear are common in individuals with type 1 skin and phenotype 1 and 2. The skin cancer is associated with chronic or intermittent, but intense sunlight. The most common malignant tumour is basal cell carcinoma, followed by squamous cell carcinoma and melanoma. The diagnosis of squamous cell skin cancer in head and neck area is usually made in the advanced stages and has a poor prognosis. MATERIAL AND METHODS: A cross-sectional, retrospective analysis was performed on the database of patients with skin cancer of the external ear treated between 2011 and 2014. Histology type, stage, rate of clinical and occult metastases, and rate of loco-regional recurrence were evaluated. RESULTS: Of the 42 patients included there were, 25 squamous cell carcinomas, 11 basal cell carcinomas, and 6 invasive melanomas. The rate of lymph node metastases in patients with squamous cell carcinoma was 32%, mostly in the parotid and peri-parotid region, 7% of them with capsular rupture, 2/17 were staged as cN0, and 11.7% had occult metastases. All patients with nodal metastasis were classified as T2 with ulceration. None of the patients with basal cell carcinoma had lymph node metastases. All melanomas were superficial extension type with mean level of Breslow of 3 mm. All underwent lymphatic mapping and sentinel node biopsy, with only one having metastases in the sentinel node. CONCLUSION: The most frequent tumour in the external ear in this series was squamous cell carcinoma. The possibility of lymph node metastases is associated with tumour size (T). Node dissection should be systematic in patients with T2 or greater.

[Dermoscopy in cutaneous melanoma]. / Dermatoscopia en melanoma cutáneo.

BACKGROUND: The mortality of cutaneous melanoma has not declined over the past 50 years. The only interventions that can reduce mortality are primary prevention and early diagnosis, and the dermoscopic evaluation is essential to achieve this. Dermoscopy identifies characteristics of melanoma that would go unnoticed to the naked eye. The aim of this paper is to report the most frequent dermoscopic findings in patients diagnosed with in situ and invasive melanoma. MATERIAL AND METHODS: An observational and retrospective study of contact dermoscopy was performed using LED DermliteTM and camera DermliteTM dermoscope. The findings evaluated were: asymmetry in two axes, association of colours, lack of pigment, irregular points, atypical network, pseudopods, blue veil, ulceration, and peri-lesional pink ring. These dermoscopic findings were compared with the histological diagnosis. RESULTS: The study included 65 patients with cutaneous melanoma; 10 in situ, and 55 invasive. The mean Breslow in invasive melanoma was 3 mm. Most patients (35) had localization in extremities. In all patients, the most frequent dermoscopic finding was asymmetry in two axes, followed by association of two or more colours; in melanoma in situ, asymmetry was the most frequent, followed by atypical-irregular points. In invasive melanoma asymmetry in two axes, the association of two or more colours, and pseudopods, were the most frequent findings. CONCLUSION: Asymmetry in two axes is the most common dermoscopic finding in in situ and invasive melanoma. The presence of two or more colours in a pigmented lesion should be suspected in an invasive melanoma.

[Thyroidectomy associated with laryngectomy in laryngeal cancer treatment. Is it routinely necessary?]. / Tiroidectomía asociada a laringectomía en el tratamiento del cáncer laríngeo, ¿es necesario efectuaria rutinariamente?

INTRODUCTION: In patients with laryngeal invasive epidermoid carcinoma who are candidates for total laryngectomy, it is recommended to resect en bloc at least half of the thyroid gland on the same side as the laryngeal tumor with the objective of decreasing local recurrence associated with thyroid infiltration. Nevertheless, in the histopathologic analysis of the specimen, a minority of thyroid glands show tumor infiltration. The fact that in these patients even partial thyroid resection is associated with hypothyroidism increased by postoperative radiotherapy is well known. The study was undertaken to determine the frequency of thyroid gland invasion in patients who have undergone total laryngectomy due to laryngeal cancer and its associated factors. MATERIAL AND METHODS: We evaluated the histological results of glands resected en bloc with laryngectomy in patients who underwent total laryngectomy due to laryngeal cancer; the clinical stage was compared to the laryngeal subsite tumor origin. The glandular histological condition was compared to the local recurrence presence (peristomal). RESULTS: Ninety two patients were included, 11 (12%) showed glandular infiltration due to epidermoid carcinoma, all with tumors clinically typified as T3 and T4, 8/11 were transglottic and only 3 (27%) showed subglottic invasion. During follow-up (5-year mean) 17/92 showed peristomal recurrence (18%), only 3 (3%) showed thyroid invasion. Among patients with glandular invasion the peristoma recurrence rate was 27% (3/11). DISCUSSION: The best laryngeal cancer thyroid tumor invasion predictor is the evidence of extralaryngeal extension. Thyroid resection en bloc should not be routinely advised due to the low frequency of glandular infiltration.