Non melanoma Skin Cancer of the Head and Neck

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Editors
Faruque Riffat Michael Veness
Westmead Hospital Westmead Hospital
University of Sydney University of Sydney
Sydney Sydney
Australia Australia

Carsten E. Palme
Westmead Hospital
University of Sydney
Sydney
Australia

ISSN 2364-4060 ISSN 2364-4079 (electronic)

Head and Neck Cancer Clinics
ISBN 978-81-322-2496-9 ISBN 978-81-322-2497-6 (eBook)
DOI 10.1007/978-81-322-2497-6

Library of Congress Control Number: 2015949116

Springer New Delhi Heidelberg New York Dordrecht London

© Faruque Riffat, Carsten E. Palme, Michael Veness, Rehan Kazi, Raghav C. Dwivedi 2015
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfilms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made.

Cover illustration by Dan Gibbons DCR(R), PgCert(CT)

Printed on acid-free paper

Springer India Ltd. is part of Springer Science+Business Media (www.springer.com)

Byword Books Private Limited, New Delhi, India (www.bywordbooks.in)
This series is dedicated to the research and charity
efforts of Cancer Aid and Research Foundation (CARF),
Mumbai, India (www.cancerarfoundation.org).
A Note on the Series

Head and neck cancer (HNC) is a major public health challenge. Its management
involves a multidisciplinary team approach, which varies depending upon the subtle
differences in the location of the tumor, stage and biology of disease, and availabil-
ity of resources. In the wake of rapidly evolving diagnostic technologies and man-
agement techniques, and advances in the basic sciences related to HNC, it is
important for both clinicians and basic scientists to be up to date in their knowledge
of new diagnostic and management protocols.
This series aims to cover the entire range of HNC-related issues through inde-
pendent volumes on specific topics. Each volume focuses on a single topic relevant
to the current practice of HNC and contains comprehensive chapters written by
experts in the field. The reviews in each volume provide vast information on key
clinical advances and novel approaches to enable a better understanding of relevant
aspects in HNC.
Individual volumes present different perspectives and have the potential to serve
as stand-alone reference guides. We believe these volumes will prove useful for the
practice of head and neck surgery and oncology. Medical students, residents, clini-
cians, and general practitioners seeking to develop their knowledge of HNC will
benefit from them.

Rehan Kazi
Raghav C. Dwivedi

vii
Foreword

Randal S. Weber

Non-melanoma skin cancer is a significant public health problem for the popula-
tions of North America, Australia, and parts of Europe. The disease is rising in
incidence and has a significant economic impact on healthcare expenditures in these
regions. Noneconomic cost is significant and includes disturbance of body image,
function, and quality of life.
Non-melanoma Skin Cancer of the Head and Neck edited by Riffat, Palme, and
Veness is a concise volume devoted to the biology, pathology, and clinical charac-
teristics of non-melanoma skin cancer. Current and future therapeutic modalities are
addressed in the setting of multidisciplinary care. The editors are recognized clini-
cal experts in the field of cutaneous malignancy management and bring their knowl-
edge and practical experience to bear in the creation of this text. Their focus on both
cutaneous and adnexal cancers of the skin is useful and will serve as a ready resource

ix
x Foreword

for both these common and uncommon malignancies. The theme of the text on
multidisciplinary intervention and care for the patient is both current and timely.
The authors are to be commended for providing a succinct source of current knowl-
edge that will inform evidence-based decisions in the management of patients with
cutaneous malignancies of the head and neck.

Randal S. Weber, MD
Professor and Chairman
Department of Head and Neck Surgery, Unit 1445
University of Texas MD Anderson Cancer Center
Houston, Texas, USA
Preface

Non-melanoma skin cancer is a global public health issue. With an ever-increasing,

and aging, world population coupled with the increasing number of immunosup-
pressed individuals, the number of patients continues to rise. The head and neck is
overwhelmingly the most frequent location for the development of a non-melanoma
skin cancer and as such challenges the clinician with its complex anatomy. The impor-
tance of maintaining the aesthetics of the face and the function of the anatomy cannot
be overstated, yet ultimately it is always the aim of curing a patient with the minimum
of morbidity that clinicians strive for. However, the spectrum of presentations and
subsequent management varies widely, ranging from patients with the ubiquitous low-
risk midface basal cell carcinoma to those diagnosed with relatively uncommon but
potentially life-threatening high-risk squamous cell carcinomas (e.g., involving meta-
static lymph nodes or with perineural invasion present) and Merkel cell carcinomas.
The concept of a multidisciplinary team approach is now the gold standard para-
digm for most patients diagnosed with cancer, and this applies no less to patients
diagnosed with non-melanoma skin cancer. While many patients with superficial
and small lesions are cured by relatively simple often non-morbid treatment, others
with more advanced cancers require a multidisciplinary team approach and often
the institution of morbid treatment.
Australians experience the highest incidence of skin cancer in the world, and Australian
clinicians are highly experienced in the management of these patients. It is the drawing
from this local experience that is the impetus behind the writing of this book. As only one
example, the requirement for extensive surgery often involving complex reconstruction
and the important role of radiotherapy are expanded on in relevant chapters by authors
widely published in their respective specialties. Many of the contributors are internation-
ally recognized experts in their particular field at the cutting edge of clinical research and
in treating patients—it is this knowledge and skill base that forms the basis of this book.
The aim of writing this book is to provide busy clinicians with easily readable informa-
tion and in most cases practical advice on managing patients with non-melanoma skin
cancer. More comprehensive textbooks are available but few offer the concise, informa-
tive, and up-to-date approach that we hope this book provides to the reader.

Faruque Riffat
Carsten Palme
Michael Veness

xi
Contents

1 Epidemiology and Aetiology of Non-melanoma Skin Cancer. . . . . . . . . 1

Zubair Hasan and Faruque Riffat
2 Pathology Reporting of Non-melanoma Skin Cancer
at the ICPMR, Westmead Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Hedley Coleman and Jeanne Tomlinson
3 Evaluation, Staging and Prognostication . . . . . . . . . . . . . . . . . . . . . . . . 25
Zubair Hasan, Carsten Palme, and Faruque Riffat
4 Non-melanoma Skin Cancer: Primary Non-surgical
Therapies and Prevention Strategies. . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Malcolm A. Buchanan, Brett Levin, and Michael Veness
5 Mohs Surgery and Facial Flaps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Dan Robinson and Jason Roth
6 Merkel Cell Carcinoma, Adnexal Carcinoma
and Basal Cell Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Michael Veness and Julie Howle
7 The Role of Sentinel Lymph Node Biopsy
in Non-melanoma Skin Cancer of the Head and Neck . . . . . . . . . . . . . 83
James Wykes, Jonathan Clark, and Navin Niles
8 Metastatic Cutaneous Squamous Cell Carcinoma
of the Head and Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Carolyn Jameson, Gary Morgan, Carsten E. Palme,
and Michael Veness
9 Managing Perineural and Skull Base Involvement . . . . . . . . . . . . . . . 117
Timothy A. Warren and Benedict Panizza
10 Squamous Cell Carcinoma Extending to the Temporal Bone . . . . . . 131
Shane Anderson, Parag Patel, and Benedict Panizza

xiii
xiv Contents

11 Reconstructive Options for the Face . . . . . . . . . . . . . . . . . . . . . . . . . . . 145

Ashlin J. Alexander, Sinclair M. Gore, and Jonathan Clark
12 Management of Critically Ill Head and Neck Surgical Patients. . . . . 171
Vineet Nayyar
13 Future Directions in the Management
of Non-melanoma Skin Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Gerard Adams and Sandro V. Porceddu
Contributors

Gerard Adams, BSc, MB ChB, MRCP, FRCR, FRANZCR Radiation

Oncology, Oceania Oncology Bundaberg, Bundaberg, QLD, Australia
School of Medicine, University of Queensland, St Lucia, QLD, Australia
Ashlin J. Alexander, MD, FRCSC Division of Facial Plastic
and Reconstructive Surgery, Department of Otolaryngology-Head
and Neck Surgery, University of Toronto, Mount Sinai Hospital
and Rouge Valley Hospital, Toronto, ON, Canada
Shane Anderson, B Biomed Sc, MBBS, FRACS, MPhil Otolaryngology-Head
and Neck Surgery, The Townsville Hospital, Townsville, QLD, Australia
Malcolm A. Buchanan, BSc, MBChB, PhD, FRCS Otolaryngology-Head and
Neck Surgery, Glasgow Royal Infirmary, Glasgow, UK
Jonathan Clark, MBBS, BSc, MBiostat, FRACS Head and Neck Surgery,
Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney,
NSW, Australia
Hedley Coleman, BDS, BChD, MDent, FCPath, FFOP Department
of Tissue Pathology and Diagnostic Oncology, Institute for Clinical
Pathology and Medical Research, Pathology West, New South
Wales Health Pathology, Sydney, NSW, Australia
Sinclair M. Gore, MD, FRCS (Plast) Plastic and Reconstructive Surgery,
Oxford University Hospitals, Oxford, UK
Zubair Hasan, MBBS, MIPH, MS Otolaryngology-Head and Neck Surgery,
Westmead Hospital, University of New South Wales, Sydney, NSW, Australia
Julie Howle, MBBS, MSurg, FRACS Department of Surgical Oncology,
Westmead Cancer Care Centre, Westmead Hospital, Westmead,
University of Sydney, Sydney, NSW, Australia
Carolyn Jameson, FRACS, PhD Head and Neck Surgery, Royal Prince Alfred
Hospital and Westmead Hospital, Sydney, NSW, Australia

xv
xvi Contributors

Brett Levin, BMedSci, MBBS, MMedSci, FRACS Otolaryngology-Head and

Neck Surgery, Westmead Hospital, Sydney, NSW, Australia
Gary Morgan Head and Neck Surgery, Westmead Hospital, University of
Sydney, Sydney, NSW, Australia
Vineet Nayyar, MBBS, MD, MPH, FRACP, FCICM Department
Intensive Care Unit, Westmead Hospital, Sydney, NSW, Australia
Navin Niles, BSc (Med), MBBS, FRACS Head and Neck Surgery, University of
New South Wales, Sydney, NSW, Australia
Carsten Palme, MBBS, FRACS Otolaryngology Head and Neck Surgery,
Royal Prince Alfred Hospital and Westmead Hospital, Sydney, NSW, Australia
Benedict Panizza, MBBS, MBA, FRACS Department of Otolaryngology − Head
and Neck Surgery, School of Medicine, University of Queensland,
Queensland Head and Neck Cancer Centre, Queensland Skull Base Unit,
Princess Alexandra Hospital, Brisbane, QLD, Australia
Parag Patel, MSc, MBBS, BSc, DO-HNS FRCS Otolaryngology-Head and
Neck Surgery, St Georges Hospitals NHS Trust, London, UK
Sandro V. Porceddu Radiation Oncology, University of Queensland, St Lucia,
QLD, Australia
Princess Alexandra Hospital, Brisbane, QLD, Australia
Faruque Riffat, BSc, MBBS, FRACS Otolaryngology-Head and Neck Surgery
Westmead Hospital, University of Sydney, Sydney, NSW, Australia
Dan Robinson, BIT, BCom, MBBS (Hons), FRACS Otolaryngology-Head and
Neck Surgery, Gold Coast University Hospital, South Port, QLD, Australia
Jason Roth, BSc, MBBS, AMusA, FRACS Otolaryngology-Head and Neck
Surgery, Private Practice, Sydney, Australia
Jeanne Tomlinson, MBBS, MBA, FRCPA FIAC Department of Tissue
Pathology and Diagnostic Oncology, Westmead Hospital, Sydney,
NSW, Australia
Michael Veness, MBBS, MMed, MD, MD, FRANZCR Radiation Oncology,
Westmead Hospital, University of Sydney, Sydney, NSW, Australia
Timothy A. Warren, BSc (Hons), MBBS Department of Otolaryngology − Head
and Neck Surgery, School of Medicine, University of Queensland,
Princess Alexandra Hospital, QIMR Berghofer Institute of Medical
Research, Brisbane, QLD, Australia
James Wykes, BSci (Med), MBBS, FRACS Head and Neck Surgery, Liverpool
Hospital, Sydney, NSW, Australia
Abbreviations

AACR Australian Association of Cancer Registries

ACE Adult comorbidity evaluation
AEC Airway exchange catheter
AIHW Australian Institute of Health and Welfare
AJCC American Joint Committee on Cancer
AK Actinic keratosis
ASA American Society of Anesthesiologists
BCC Basal cell carcinoma
CAM-ICU Confusion assessment method for ICU
CI Charlson index
CIRS Cumulative illness rating scale
CK Cytokeratin
CLL Chronic lymphocytic leukemia
CNI Calcineurin inhibitor
CNS Central nervous system
COPD Chronic obstructive pulmonary disease
COSA Clinical Oncological Society of Australia
cSCC Cutaneous squamous cell carcinoma
CT Computed tomography
DAS Difficult Airway Society
DFS Disease-free survival
DFSP Dermatofibrosarcoma protuberans
DSS Disease-specific survival
DVT Deep vein thrombosis
EAC External auditory canal
EAM External auditory meatus
EBV Epstein−Barr virus
ECS Extracapsular spread
EGFR Epidermal growth factor receptor
ENS Extranodal spread
ENT-HNS Otorhinolaryngology and head and neck surgeon
ETT Endotracheal tube
FAMM Facial artery musculomucosal
[18F]
FDG-PET Fluorodeoxyglucose positron emission tomography

xvii