Challenges in the Complex Management of Neglected Cutaneous Melanomas in the Head and Neck Area: A Single Center Experience.

Familiar controversies in the management of head and neck melanomas are more remarkable in locally advanced cases, and they represent a treatment challenge both surgically and oncologically. In our retrospective study, patients with surgically treated primary malignant melanoma of the head and neck region larger than 3 cm in diameter were included. Five patients met our inclusion criteria. In all cases, wide excision and immediate reconstruction were performed without sentinel lymph node biopsy. The defect on the scalp was covered by a split skin graft, with local flaps chosen for reconstruction on the face on an individual basis. After a 2-6 year follow-up, a good oncological, functional, and esthetic result was achieved. Our results show that in the case of large, locally advanced melanomas, surgical treatment still plays a crucial role that can provide long-term local control and support the effect of systemic treatment.

Minimally invasive peroral endoscopic removal of a regurgitated giant polysegmented fibrovascular polyp of the esophagus.

Giant fibrovascular polyps (FVP) are relatively rare benign neoplasms of the upper part of the esophagus. Without a previous history, their diagnosis might be difficult because the endoscopic findings are sometimes misinterpreted. The present report describes a case in which the patient regurgitated a giant polypoid mass into his mouth and captured it between his teeth and buccal surface until emergency endoscopic removal. Although the adequate therapy for these lesions is open surgical resection, most often via cervical esophagotomy, in our case the polyp was removed successfully by peroral endoscopy with minimally invasive surgery. After 5 years of follow-up the patient is doing well, without recurrence.

Peroral endoscopic removal: as a minimally invasive long-term surgical treatment of a regurgitated giant polisegmented fibrovascular polyp of the esophagus.

Giant fibrovascular polyps (FVP) are relatively rare benign neoplasm of the upper part of the esophagus. Without previous history, their diagnosis might be difficult as the endoscopic findings are sometimes misinterpreted. The present report describes a case, in which the patient regurgitated his giant polypoid mass into his mouth and captured it between his teeth and buccal surface until the emergency endoscopic removal. Although the adequate therapy for these lesions is mainly the open surgical resection, most often via cervical esophagotomy, in our case the polyp was removed successfully by peroral endoscopic operation, as a minimally invasive surgical treatment. After 5 years of follow-up, the patient is doing well, without recurrence of his polyp.

[Ectomesenchymal chondromyxoid tumor of the tongue, a rare and benign lesion]. / A nyelv ritka, benignus, ectomesenchymalis chondromyxoid tumora.

Ectomesenchymal chondromyxoid tumor is a rare benign intraoral soft tissue neoplasm. Till date, 93 cases have been reported in literature. Clinically, it presents as a slowly growing, painless, firm, submucosal swelling mainly occurring on the anterior two thirds of the dorsum of the tongue. Histopathologically, the tumor is characterized by a well circumscribed, lobular proliferation of round, polygonal, or fusiform cells in a net-like pattern in a myxoid to chondromyxoid background. Although it shows a morphological resemblance to myoepitheliomas of soft tissue and skin, the exact histogenesis remains unclear; a recent publication of a large series has demonstrated recurrent RREB1-MKL2 gene fusions in 90% of the cases, suggesting the possibility of a new entity. The diagnosis is largely supported by immunhistochemical investigations. Here, we present a new case of ECT occurring in a 62-year-old male who presented with a leading complaint of slowly growing painless mass arising from the anterior part of the tongue measuring about 3 cm. This lesion was diagnosed 4 years before recent admittance, but the patient did not undergo the scheduled surgical intervention and was lost to follow-up. As the tumor was still persisting and moderately enlarging, he came back to our clinic. Finally, the mass was completely resected; after 24 month of follow-up, he is doing well, with no signs of recurrence. Orv Hetil. 2019; 160(33): 1319-1323.

An anterolateral thigh chimeric flap for dynamic facial and esthetic reconstruction after oncological surgery in the maxillofacial region: a case report.

BACKGROUND: The surgical management of malignant tumors in the head and neck region often leads to functional and esthetic defects that impair the quality of life of the patients. Reconstruction can be solved with prostheses in these cases, but various types of microsurgical free flaps can provide a better clinical outcome. CASE PRESENTATION: In this case report, the tumor and parts of the involved facial muscles and nerve were excised surgically from a 42-year-old patient after a third relapse of basal cell carcinoma in the left midface. The tissue defect was reconstructed with an anterolateral thigh chimeric type I fascio-myocutaneous flap, where the facial palsy was restored with a segmental branch of the femoral nerve and the involved mouth corner elevator muscles for the segmented vastus lateralis muscle. The 6-month follow-up revealed a good esthetic outcome, the soft tissue defect reconstruction with good functional activity of the reconstructed facial nerve and with acceptable mimic movements. There has been no subsequent recurrence. CONCLUSIONS: It is concluded that the chimeric type I anterolateral fascio-myocutaneous free flap can offer a good option for the esthetic and functional reconstruction of an extensive tissue defect in the maxillofacial region.

Effective chemoradiotherapy without additive toxicity in locoregionally advanced head and neck cancer.

A previous preclinical study revealed that the maximum additive effect between chemotherapy (CT) and irradiation (RT) occurred at a low level of CT. Therapy was therefore designed with an oral drug daily given in combination with RT in order to determine the efficacy and toxicity. Locoregionally advanced head and neck tumor patients were treated with simultaneous RT and CT. RT was administered 5 times per week at 2 Gy per fraction to a total dose of 70 Gy. Throughout the treatment 30 mg/kg Tegafur was given daily orally. In the period between 2000 and 2002, 50 patients were enrolled. In 60%, complete remission was attained with an overall response rate of 94%. Acute mucositis of grade 2 or 3 was observed in 56% (28 patients), while gastrointestinal and hematological toxicity of grade 2 or 3 occured in 8% (4 patients). Because of side-effects, the duration of treatment was at most 2 weeks long. Toxicity was eliminated quickly by careful supportive therapy. In conclusion, it is considered that oral low-dose CT in combination with RT is an efficient and simple mode of treatment for locally advanced head and neck tumor patients with a poor prognosis.

[Radiotherapy in combination with low-dose chemotherapy in locally advanced head and neck cancer]. / Kis dózisú kemoterápiával kombinált sugárterápiával szerzett eredményeink lokálisan elôrehaladott stádiumú fej-nyaki rákban.

A previous preclinical study revealed that the maximal additive effect between chemotherapy (CT) and irradiation (RT) occurred at a low level of CT. Therapy was therefore designed with an oral drug daily given in combination with RT in order to determine the efficacy and toxicity. Locoregionally advanced head and neck tumor patients were treated with simultaneous RT and CT. RT was administered 5 times per week at 2 Gy per fraction in a total dose of 70 Gy. Throughout the treatment 30 mg/kg Tegafur was given daily orally. In the period between 2000 and 2002, 50 patients were enrolled. Complete remission was attained in 60%, with an overall response rate of 94%. Acute mucositis of grade 2 or 3 was observed in 56% (28 patients), and gastrointestinal and hematologic toxicity of grade 2 or 3 occurred in 8% (4 patients). Because of side-effects, the duration of treatment was at most 2 weeks longer. Toxicity was eliminated quickly by careful supportive therapy. In conclusion, it is considered that oral low-dose CT in combination with RT is an efficient and simple mode of treatment for locally advanced head and neck tumor patients with a poor prognosis.

Autofluorescence videoendoscopy for photodiagnosis of head and neck squamous cell carcinoma.

The diagnosis of head and neck squamous cell carcinoma is usually made by visual identification. Searching for a non-invasive optical diagnostic method with the ability to detect the precancerous lesions or second primary tumors earlier in high-risk populations led to the development of photodiagnosis by autofluorescence (AF) endoscopy. The aim of the present study was to evaluate and discuss the diagnostic potential of autofluorescence videoendoscopy as a complementary visual aid in the routine endoscopic diagnosis of head and neck cancers. In a prospective study, 48 patients underwent white light (WL) videoendoscopy followed by AF technique at the Institute of Gustave-Roussy from November 2001 to August 2002. Of 48 patients, 30 had suspected precancerous or cancerous laryngeal lesions, 7 presented benign laryngeal lesions, while 8 showed pharyngeal and 3 oral tumors. All detected lesions were evaluated by histological examination. AF was induced by filtered blue light of a xenon short arc lamp and processed by a CCD camera system (D-Light AF System; Storz, Tuttlingen, Germany). Normal laryngeal mucosa displayed a typical green fluorescence signal. Moderate and severe epithelial dysplasia, carcinoma in situ and invasive carcinoma showed a diminished green fluorescence and presented a marked reddish-blue color. In case of hyperkeratosis a bright white color was detected. Some benign lesions, such as granulomas, polyps and papillomas also displayed altered green fluorescence. Autofluorescence videoendoscopy for photodiagnosis of head and neck squamous cell carcinomas has proved to be a method of high specificity and good sensitivity. Two additional precancerous lesions that were invisible at the WL examination but detected with the AF technique show its potential role in the regular screening procedure or follow-up examination in a high-risk population. It was a very helpful complementary visual aid for the intraoperative control of the surgical margins after per oral endoscopic resection.