AAO-HNSF Primary Care Otolaryngology Handbook

CHAPTER 16

Skin Cancer

The great majority of skin cancers arising on the skin of the face, scalp, and neck are basal cell carcinoma , followed by squamous cell carcinoma, then malignant melanoma . Basal cell carcinoma is very common and most often occurs on the face, so the otolaryngologist–facial plastic surgeon sees many cases.

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The typical basal cell carcinoma is a nodular lesion with a raised, pearly- white border (Figures 16.1 and 16.2). These lesions are usually brought to the physicians’ attention before they become very large (Figure 16.3). They do not metastasize and can be treated in a variety of ways. Derma- tologists may freeze or curette them. When the patient is referred to an otolaryngologist–head and neck surgeon, the lesions are usually excised with a 3–4-mm margin, followed by a meticulous closure of the defect, which occasionally requires a rotation or advancement flap from the neighboring skin. These flaps restore cosmetic integrity to the facial unit affected by the tumor. Another approach to resecting basal cell and some squamous cell cancers involves Mohs’ fresh-tissue chemo- surgery technique . This technique requires tumor mapping: using small, sequential tumor resection in layers

Figure 16.1. Basal cell carcinoma. Photo: jax10289/shutterstock.com.

Figure 16.2. Basal cell carcinoma of the temporal region. Photo: Nau Nau/shutterstock.com.

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