MANAGEMENT OF SKIN TUMORS OF THE FACE AND NECK
All cutaneous tumors of the cephalic extremity (scalp, face and neck) irrespective of their stage, can be treated by the Cervico-Facial Oncological Surgery Department within the University Institute of Face and Neck. Some particularly aggressive forms depending on the histological type, stage or location are prioritised:
- Basal cell carcinoma (BCC) infiltrating, scleroderma-like or recurrent and / or irradiated
- Cutaneous squamous cell carcinoma (PCS) with identified lymph node metastatic potential
- Adnexal carcinomas
- Cutaneous malignant melanoma (MMC)
- Cutaneous neuroendocrine carcinomas (Merkel tumors)
- Cutaneous sarcomas
- Dermato fibrosarcomas of Darier-Ferrand
- Periorificial locations (lips, mouth, nostrils, eyelids, external auditory canal …)
- Locations with high lymph node risk (forehead, scalp, outer ear …)
- Some benign skin tumors such as recurrent keloids that can be treated by radio-surgical combination
All forms that require complex repair by specialized techniques, either by their periorificial location (nose, lips …), or for advanced forms where an extensive integumentary carcinological excision will be necessary or even in case of tumor recurrence after surgery or radiotherapy.
The vast majority of skin cancers of the face and neck at all stages can be treated by surgery:
- Surgery of initial cutaneous tumor, first intention or in case of recurrence.
- Carrying out ystematic histopathological evaluation. Mastery of extemporaneous examination and Mohs technique which aims to reduce the risk of recurrence by sparing the cutaneous capital of the face.
- Complementary lymph node-specific surgery, depending on the case, thanks to the “minimal invasive” sentinel lymph node search technique or the performing of appropriate lymph node dissection with parotidectomy preserving the facial nerve if necessary.
- Simple and complex restorative surgery using tissue graft (skin, cartilage), skin expansion (expander) or a wide variety of flaps. That is to say, using tissue taken either from near the face (local flap) or at distance (pedicled flap) or remotely removed and revascularized by vascular microanastomoses.
In some cases, non-surgical treatments that are exclusive or complementary to surgery may be used:
- External radiotherapy, most often complementary after surgery for certain aggressive tumors.
- High rate interstitial brachytherapy, exclusive, for certain anatomical locations such as the lips.
- Contact therapy or localized radiotherapy in contact with small tumors, proposed exclusively for certain superficial basal cell carcinomas (eyelids).
General drug treatment (chemotherapy, immunotherapy) in some cases for more aggressive tumors
DEPARTMENT OF ONCOLOGICAL CERVICO-FACIAL SURGERY
Dr Gilles Poissonnet
Pr Alexandre Bozec
Dr Dorian Culié
DEPARTMENT OF MEDICAL ONCOLOGY
Dr Esma Saada
Dr Damien Giacchero (dermatology)
Dr Jérôme Doyen
A multidisciplinary team provides diagnosis and treatment.This team participates in the Multidisciplinary Committee of ENT Neoplasms of the Face and Neck and collaborates closely with the Multidisciplinary Committees of Hematology-Sarcoma-Dermatology Organ of the center and the Multidisciplinary Committee of Onco-Dermatology of the CHU of Nice (Pr JP Lacour). All meet in Multidisciplinary Consultation Meetings.
It is also engaged in collaboration with the University Hospital of Nice in research projects on malignant melanoma.
• Laboratory of Pathology Anatomy and Cytology of the University Hospital of Nice (Pr Paul Hofman)
• IUMR S 597 Biology and pathology of melanocytic cells, from skin pigmentation to malignant melanomas – (Dr Robert Ballotti [ISERM], Pr Jean-Paul Ortonne [UNSA-CHU], Pr Philippe Bahadoran [UNSA-CHU])
Complete surgical management within the IUFC is provided after consultation and clinical examination together with preoperative anesthetic consultation for both local anesthetic (without tracheal intubation) or under general anesthetic. Surgery can often be performed as an outpatient.