Importance of anatomical site in the metastases of auricular cutaneous squamous cell carcinoma: an observational study.

Malignancies of the auricular skin tend to metastasise to preauricular, parotid, facial, and level II (possibly to levels IV and V) lymph nodes in an unpredictable manner. Over the years, we have observed that this pattern of metastasis is commonly linked to lesions that involve the lower half of the ear. To find conclusive evidence based on this hypothetical observation, we retrospectively studied 108 patients who presented with squamous cell carcinoma (SCC) of the ear, and looked at the exact auricular site of the lesion at presentation, incidence of metastasis, nodal involvement, treatment, and survival outcome. The literature was reviewed extensively to ensure detailed presentation of the lymphatic drainage pathway. The pattern of spread and outcome were evaluated. This study has shown that there is a significant correlation between anatomical position and risk of metastasis, and that lesions of the lower half of the ear are more prone to metastasis. These patients therefore may warrant early imaging, possible sentinel node biopsy, or even selective neck dissection with simultaneous primary excision.

Revisiting lip shave: a solution for disorders of the vermilion border.

Actinic keratosis, leukoplakia, carcinoma in situ, and superficially invasive carcinomas of the lower lip are caused mainly by the cumulative effects of exposure of the vermilion of the lower lip to ultraviolet radiation. Current treatments all have limitations: cryosurgery or electrosurgery is suitable to treat only focal lesions; topical chemotherapy, which is an option for diffuse actinic damage, yields unreliable results; and laser treatment fails to rejuvenate the vermilion. However, "lip shave", which involves full-thickness excision of the damaged vermilion and reconstruction with an advancement labial mucosal flap, will produce a fresh mucosal lining to the vermilion border. We describe our experience of the technique and evaluate the functional and aesthetic outcomes in 20 patients treated between January 2011 and January 2016. The follow-up period ranged from 24 to 60 months. Three-quarters of the patients had dysplasia or superficially invasive malignancy. Resected lesions were about 63mm long, 13.7mm wide, and 3.9mm deep. No patients had recurrence or secondary lesions during follow up, functional disturbance was minimal, and the cosmetic outcome pleasing. Lip shave can efficiently reconstruct the vermilion of the lower lip with minimum deformity.

Squamous cell carcinoma of the anterior tongue: is tumour thickness an indicator for cervical metastasis?

The incidence of squamous cell carcinoma (SCC) of the tongue accounts for 90% of all malignancies affecting the oral cavity and oropharynx. The distribution between the anterior and posterior tongue is equal. Nodal metastasis is dependent on various factors including tumour thickness, site, size, differentiation, and perineural and perivascular invasion. There is increasing evidence of a close correlation between tumour thickness and metastasis. A retrospective study covering the 16-year period from 2000 to 2016 was performed. Eighty-one patients with anterior tongue SCC were included. The only primary treatment was surgery. All patients were T1/T2N0M0 stage. Sixty-five patients underwent local excision with simultaneous selective neck dissection; 29 of these patients were confirmed to have occult metastasis. Sixteen patients underwent local excision only as an initial treatment. Four of them subsequently developed neck metastasis within a 6- to 18-month period. The results of this study support recent publications associating tumour thickness with nodal disease. Therefore, it is postulated that prophylactic neck dissection should be considered when the tumour thickness of anterior tongue SCC exceeds 5mm, in order to prevent lymphatic spread and improve the survival rate.

Reconstruction of the lower lip using bilateral commissurotomy and advancement of skin, muscle, and mucosal flaps.

Reconstruction of a composite defect of the lower lip after oncological resection is challenging, and it is essential to consider both functional and aesthetic components when repairing lips. We report a technique that can be used to repair anything ranging from 30% to the whole of the lower lip with a bilateral commissurotomy and advancement of skin, muscle, and mucosal flaps. This technique helps to achieve good oral function, excellent lip function, and a pleasant aesthetic appearance. It also prevents microstomia and allows patients to maintain normal sensory innervation.