The Assessment of the Long-Term Impact of Radiotherapy on Biophysical Skin Properties in Patients after Head and Neck Cancer.

Background and Objectives: Chronic radiotherapy-induced skin injury (cRISI) is an irreversible and progressive condition that can significantly impact a patient's quality of life. Despite the limited literature available on the assessment of the epidermal barrier in cRISI, there is a consensus that appropriate skincare, including the use of emollients, is the primary therapeutic approach for this group of patients. The aim of this study was to evaluate the biophysical properties of the skin during the late period (at least 90 days) following radiation therapy (RT) for head and neck cancer. Materials and Methods: This was a single-center prospective non-randomized study. It involved the analysis of 16 adult patients with head and neck cancer who underwent RT at the Greater Poland Cancer Center, along with 15 healthy volunteers. The study and control groups were matched for gender and age (p = 0.51). Clinical assessment, based on the LENT-SOMA scale, was conducted for all patients. Evaluation of the skin's biophysical properties included: an analysis of transepidermal water loss (TEWL), stratum corneum hydration (SCH), and skin visualization using high-frequency ultrasonography (HF-USG). Results: A significantly higher TEWL was observed in the irradiated area compared to the control area in the study group (p = 0.004). However, there was no statistically significant difference in SCH (p = 0.073). Additionally, no significant difference was observed in the values of TEWL and SCH in the irradiated area between the group of patients with and without clinically obvious RISI (p = 0.192 and p = 0.415, respectively). The skin thickness of the irradiated area, assessed by HF-USG, did not differ significantly from the skin thickness of the control area (p = 0.638). Furthermore, no difference in skin thickness was observed in patients with clinical features of cRISI in the irradiated and control areas (p = 0.345). The mean time after RT was 6.1 years. Conclusions: This study marks the first demonstration of epidermal barrier damage in patients in the long term following RT for head and neck cancer. The impairment of the epidermal barrier was observed independently of evident cRISI features. This observation underscores the necessity to recommend appropriate skin care, including the use of emollients, for all patients following RT. We also suggest that HF-USG examination is generally inconclusive in determining the degree of skin damage in the late period after RT.

The impact of the COVID-19 pandemic on the management of head and neck cancer patients at a tertiary care institution in Poland.

AIM OF THE STUDY: To assess the impact of the COVID-19 pandemic on the diagnosis and treatment of patients at a tertiary hospital in Poland. MATERIAL AND METHODS: This was a retrospective review of head and neck cancer patients who presented to the multidisciplinary tumour board (MTB) during the 12-month period from March 2020 to February 2021 and compared to patients who presented to the MTB during the prior, pre-pandemic 12-month period from February 2019 to March 2020: Patient demographic and clinical variables were compared: sex, age at diagnosis, distance from hospital, date of first visit, radiological diagnosis, pathology specimen, MTB meeting, and initiation of primary and adjuvant treatment. RESULTS: The number of patients who presented to the MTB increased by 22% (278 to 340) from the pre-pandemic to the pandemic period. The mean time from MTB presentation to treatment initiation increased significantly from 17.1 to 21.7 days. The mean time from first visit to treatment start increased from 44.7 to 54.4 days. The proportion of patients with early-stage oropharyngeal cancer who underwent primary surgery rose from 47.3% to 86.6%. The percentage of patients who received palliative radiotherapy increased from 20.5% to 32.9%. The proportion of patients who received best supportive care rose from 1.8% to 6.2%. CONCLUSIONS: One of the most notable findings of this study was the increased time from first visit to treatment initiation, which could negatively impact patient outcomes. The differences in the treatment received in these two periods should be further evaluated to determine their influence on survival.

An ultrasonographic monitoring of skin condition in patients receiving radiotherapy for head and neck cancers.

Radiodermatitis is one of the commonest side effects of radiotherapy. They are usually assessed by semi-quantitative clinical scores, which are not validated and may be subject to inter-observer variability. A few previous studies suggested that high-frequency ultrasonography (HF-USG) is useful in the assessment of the acute phase of radiation dermatitis in breast cancer patients. (a) To monitor skin changes by HF-USG during the course of radiotherapy due to head and neck cancers, and (b) to determine whether there is any connection between skin sonograms and the skin scoring criteria. This prospective, observational study includes patients diagnosed with head and neck cancers, treated with radiotherapy or concomitant chemoradiation. The final analysis includes six patients. In every patient, the HF-USG as well as dermatological assessment (target lesion score-TLS and CACE v. 4.0) were performed 4×: before, in the middle, day after, and 3 months after radiotherapy. There were significant differences between non-irradiated skin thickness and thickness of skin with clinically obvious radiodermatitis (TLS grade 1-4; P < .0001), as well as between irradiated, unchanged skin thickness (TLS grade 0) and thickness of skin with clinically obvious radiodermatitis (TLS grade 1-4; P = .0002). There was no significant difference between non-irradiated and irradiated, unchanged skin thickness (TLS grade 0; P = .9318). In four patients, we demonstrated subepidermal low echogenic band (SLEB). HF-USG can be useful tool to noninvasive and objective assessment of skin changes during radiotherapy.

Management of clinically negative neck in salivary gland cancers - elective neck dissection, irradiation, or surveillance?

AIM OF THE STUDY: To retrospectively assess treatment outcomes among patients treated for salivary gland cancers at our institution to determine which of the three most common treatment approaches - elective neck dissection (END), elective neck irradiation (ENI), or observation - provide the best results. MATERIAL AND METHODS: A total of 122 patients were identified who had undergone primary surgery for SGC followed by END, ENI, or observation. The patients were classified into three groups according to the treatment approach used to manage the neck: END, ENI, or observation. The main outcome measures were disease-free survival (DFS) and overall survival (OS). We also sought to identify the risk factors potentially associated with neck metastasis and treatment failure. RESULTS: 106 patients met all inclusion criteria. Of these 106 patients, 27 (25.7%) underwent END, 17 (16.0%) underwent ENI, and 62 (58.5%) observation. There were no statistically significant differences between the three groups in any of the following variables: advanced age (> 70); presence of locally advanced disease (T3 or T4); perineural invasion; lymphovascular invasion; and primary tumour location. Treatment failure was higher (non-significantly) in the END group (25.9%) vs. the observation (21.0%) and ENI (11.8%) groups. No differences (Kaplan-Meir curves) were observed among the three groups in terms of DFS or OS. CONCLUSIONS: Our results show that elective neck dissection does not appear to provide any benefit to patients treated for malignant salivary gland cancer. Importantly, these findings contradict most of the currently available research. However, due to methodological differences among the available studies, our findings cannot be compared directly to other studies.

Skin barrier function in patients under radiation therapy due to the head and neck cancers - Preliminary study.

AIM: To present the possibility of non-invasive monitoring of the skin after radiotherapy in regards of epidermal barrier function. BACKGROUND: Radiodermatitis constitutes 95% of all side effects in patients after radiotherapy. The proper assessment of the severity of radiodermatitis can be determined using semi-quantitative clinical scores [Common Terminology Criteria for Adverse Events v 4.0 (CTCAE)].The most accepted way to analyze the epidermal barrier function is to determine Transepidermal Water Loss (TEWL). MATERIAL AND METHODS: In prospective study, we included 16 patients diagnosed with head and neck cancer treated with radiotherapy or concomitant chemoradiation in whom we performed non-invasive assessments of the skin barrier function, including TEWL measurement. The final analysis included 6 patients (4 treated with adjuvant radiotherapy, 2 with radical chemoradiation). Clinical assessment of irradiated skin was based on target lesion score (TLS) and CTCAE v 4.0. RESULTS: The mean TLS score in the middle of irradiation was 1.6 points, after last irradiation it was 2.3 points; 3 months later the mean TLS score was: 0. CTCAE v 4.0 criteria: 2 patients had grade 0, 3 patients - grade 1; 1 patient - grade 2. There were statistically significant differences in TEWL related to irradiated skin in the following time intervals: before vs. in the middle; before vs. day after; in the middle vs. day after; in the middle vs. 3 months after; day after vs. 3 months after. CONCLUSIONS: The study showed that radiotherapy causes skin barrier dysfunction in all patients independently of clinical radiodermatitis. The biophysical features of this dysfunction can precede clinical symptoms and they can be assessed by non-invasive and objective methods.

Outdoor work as a risk factor for high-grade cutaneous squamous cell carcinoma of the head and neck.

INTRODUCTION: While it is clear that individuals with outdoor occupations are at a significantly greater risk of developing cutaneous squamous cell carcinoma (cSCC), no previous studies have investigated the potential association between the tumour grade and occupation in this patient population. AIM: To assess occupation as a risk factor for the development of high-grade cSCC. Secondarily, to determine the association between the tumour grade and other clinical characteristics. MATERIAL AND METHODS: Retrospective analysis of 256 patients treated for head and neck cSCC at our institution in 2007-2016. The following patient characteristics and variables were assessed: age; sex; tumour location and grade; profession; and education level. A univariate analysis was performed to assess the association between each study variable and grade 3 tumour differentiation. RESULTS: The following variables were significantly associated (p < 0.05) with grade 3 (G3) cSCC tumours: outdoor work vs. indoor work; primary school vs. high school education; and age. Additionally, patients with low-grade (G1) tumours were significantly younger (mean age: 72) than patients with high-grade (G3) tumours (mean age: 79) (p = 0.046). CONCLUSIONS: To our knowledge, this is the first study to assess the variables associated with the tumour grade among outdoor workers. These findings suggest that outdoor workers who develop cSCC are at a greater risk of developing more aggressive cancers. These findings provide additional support for classifying cSCC as an occupational disease. Early education about the dangers of sun exposure during the first years of school is essential to minimize the risks of developing high-grade skin cancer.

Patterns of treatment failure in salivary gland cancers.

AIM: The purpose of the study was to publish our experience of salivary gland cancer treatment with large number of patients treated at a single institution. BACKGROUND: Salivary gland cancers are rare tumors of the head and neck representing about 5% of cancers in that region and about 0.5% of all malignancies. Due to the rarity of the disease, most of the studies regarding treatment outcome consist of low number of patients, thus making it difficult to draw conclusions. MATERIAL AND METHODS: 115 patients with primary salivary gland cancer were included in a retrospective study. The subsites of tumor were the parotid gland (58% patients), submandibular gland (19%) and minor salivary glands (23%). All patients underwent primary surgical resection. The following were collected: age, stage of the disease, T status, N status, grade of tumor, perineurial invasion, lymphovascular invasion, extracapsular spread, final histological margin status and postoperative treatment. Details of local, regional or distant recurrence, disease free survival and overall survival were included. RESULTS: The majority (65%) of patients presented in early stage, T1 and T2 tumors. 81% of patients were N0. Free surgical margins were achieved in 18% of patients, close in 28% patients and positive surgical margins in 54% (62) patients. Factors that significantly increased the risk of recurrence: T stage (p = 0.0006); N-positive status (p < 0.0001); advanced stage of the disease (p < 0.0001); high grade of tumor (p = 0.0007); PNI (p = 0.0061); LVI (p = 0.0022); ECS (p = 0.0136); positive surgical margins (p = 0.0022). On multivariate analysis, high grade of tumor and positive surgical margins remained significant independent adverse factors for recurrence formation. CONCLUSIONS: This report shows a single institution results of oncological treatment in patients with malignant salivary gland tumors, where positive surgical margins strongly correlate with patients' worse outcome. Whether to extend the procedure, which very often requires sacrificing the nerve is still a question of debate.

Multivariate analysis as an advantageous approach for prediction of the adverse outcome in head and neck microvascular reconstructive surgery.

BACKGROUND: The use of a free flap has become a mainstay of reconstruction following the ablative surgery in head and neck. The success rates are about 90%, however, several factors have been described to have an adverse effect on free flap survival. METHODS: We have performed a retrospective analysis of the treatment outcome of 93 microvascular flaps and evaluated the factors influencing the risk of flap loss including patients' age, body mass index, smoking, general medical history and previous oncological treatment. RESULTS: Out of 93 flaps the total necrosis have been observed in 15 flaps with gradual improvement in the consecutive years. In individual analysis the patients age, BMI, and comorbidities did not reveal any significant relation. The history of any previous oncological treatment represented a significant adverse factor of success rate (p=0.035), and was even more significant when patients experienced all treatment modalities prior to the reconstructive procedure (p=0.009). Multivariate logistic regression model indicated that only surgery (p=0.0008), chemotherapy (p=0.02), cardiovascular diseases (p=0.05) and patient's age (p=0.02) represented significant factors impairing the success rate. CONCLUSION: Incorporating multivariate analysis represents important statistical approach for better prediction of free flaps survival in head and neck reconstructive surgery. Incorporation of additional collective information could provide more precise approach in the risk of the flap loss assessment.

Microbiological analysis of acute infections of the nail fold on the basis of bait thread test.

INTRODUCTION: An acute infection of the nail fold, called paronychia, is a common clinical problem. The basis for the implementation of the treatment is the result of microbiological examination. Due to the rapid and painful course of infection, usually an empirical antimicrobial treatment prior to obtaining microbiological test results is introduced. AIM: The microbial analysis of acute infections of the nail fold. MATERIAL AND METHODS: The study included 32 tests conducted on 31 patients of the Department of Dermatology. Microbiological analysis was performed with the use of the so-called bait thread test. RESULTS: In 73% of analyzed cases microbiological examination revealed mixed microbiological flora. Most cultured microorganisms were: Enterococcus faecalis (14%), Staphylococcus aureus (12%), Candida albicans (9%), Enterobacter cloacae (8%), and Klebsiella pneumoniae (7%). Most cultured bacteria belonged to the families or genera of Enterobacteriaceae (36%), other cultured bacteria were staphylococci (26%), enterococci (16%), Candida species (14%), and Gram-negative non-fermenting bacilli (8%). CONCLUSIONS: The acute infection of the nail fold in the vast majority of cases is caused by mixed bacterial flora. A profile of isolated microorganisms suggests that the cause of the infection can be associated with neglect of hygiene. Fluoroquinolone and fusidic acid are recommended as the empirical therapy. Microbiological examination is the basis for the appropriate final treatment.

Is immunohistochemical evaluation of p16 in oropharyngeal cancer enough to predict the HPV positivity?

AIM: Our goal was to determine the expression levels of p16 in the cohort of the OPSCC patients and evaluation of the pathological and clinical differences between these two groups including patients' survival. BACKGROUND: HPV infection is the main causative factor of oropharyngeal cancer (OPSCC). Identification of HPV status in OPSCC requires positive evaluation of viral DNA integration into host cell however, p16 accumulation in the proliferating cell layers has been accepted as an alternative marker for HPV infection. MATERIAL AND METHODS: The IHC staining for p16 has been performed in tumor tissue from 382 OPSCC patients. The sample was considered positive based on more than 70% of carcinoma tissue showing strong and diffused nuclear and cytoplasmic immunostaining. The clinicopathological characteristics of the patients including site, age, gender, tumor grade, tumor stage, the nodal status, smoking and survival have been analyzed when comparing p16 positive and p16 negative tumors. RESULTS: Out of our cohort in 38.2% cases positive staining for p16 has been recorded. Our analysis did not indicate significant differences in the distribution of the p16 positive patients and age of the patients, stage of the disease. Among the patients who have presented with the N+ neck, there were significantly more p16 positive tumors than in the group with N0 neck (p = 0.0062). There was highly significant correlation between the expression of p16 and smoking (p < 0.0001). The significant difference in survival (p < 0.0001) with more favorable prognosis in the p16 positive group has been observed. CONCLUSIONS: Overexpression of p16 is accepted as a surrogate diagnostic marker for detecting HPV infection in oropharyngeal cancer. However, one should remember about existence of the small subgroups of p16 positive but HPV negative tumors, with relatively worse prognosis. Immunostaining for p16, however useful on everyday basis, should be complemented with other techniques in terms of reliable identification of the HPV infection.

Basal cell carcinoma in farmers: an occupation group at high risk.

INTRODUCTION: Skin cancer is the most commonly diagnosed cancer type worldwide, and 80 % of skin cancers are basal cell carcinoma (BCC). The main risk factor for developing BCC is exposure to ultraviolet radiation (UVR), particularly high-dose exposure at a young age. Outdoor workers, particularly farmers, are at high risk of developing BCC. However, studies of BCC in this population are scant. OBJECTIVE: To comprehensively evaluate all cases of BCC of the head and neck region treated during the years 2007-2013 at our hospital in Poland, and to compare the tumour characteristics in farmers to non-farmers. MATERIALS AND METHODS: Retrospective analysis of 312 patients treated for head and neck BCC during the study period (2007-2013). RESULTS: Most patients (198 cases; 63 %) were males, with 114 females (37 %). Median age was 73 years (range 32-96 years). The most common tumour location was the nose and cheek (114 pts; 37 %) followed by the auricle (82 pts; 26 %), lips (54 pts; 18 %), scalp (26 pts; 8 %), and eye (36 pts; 12 %). The most common disease stage on presentation was stage T2 (104 pts, 33 %), followed by stage T1 (79 pts; 25 %), stage T3 (89 pts; 28 %), and stage T4 (40 pts; 14 %). By occupation, farmers accounted for 33 % of all patients (102 of 312 pts). The most common tumour localisations in the farmer subgroup were the nose and cheek (50 pts; 49 %; p < 0.001; odds ratio [OR] 2.19; 95 % confidence interval [CI] 1.35-3.57), followed by the auricle (32 pts; 31 %), scalp (16 pts; 16 %), ocular region (3 pts; 3 %), and lips (1 pt; 1 %). Patients in the farmer group were significantly younger than non-farmers (62 vs. 73 years; p < 0.001; OR 0.90, 95 % CI 0.88-0.93). Farmers were significantly more likely to present disease recurrence (27 vs. 12 % of cases; p < 0.001; OR 5.94; 95 % CI 2.86-12.33). CONCLUSION: The results highlight the increased incidence and risk of recurrence of BCC in farmers. It is therefore necessary to consider enhancing educational programmes and other preventative measures in this occupational group and to evaluate the effectiveness of such programmes.

Analysis of selected risk factors for nodal metastases in head and neck cutaneous squamous cell carcinoma.

Cutaneous squamous cell carcinoma (cSCC) accounts for 20% of all skin malignancies and 20% of deaths. In contrast to mucosal SCC, treatment results are very good. However, regional metastases are present in 5-20% of cases, and the prognosis for patients with metastases is 50% lower. It has been reported that several risk factors are responsible for the head and neck lymph node regional metastasis, such as: poor cell differentiation, local recurrence, immunosuppression, and tumour dimension. Multivariate analysis of metastatic neck lesions in head and neck cSCC. Retrospective analysis of patients treated at our department for head and neck cSCC. The study includes 100 patients: 66 males (66%) and 34 females (34%), aged 26-98 years (mean age 74.6). The tumour was evaluated for: sex predilection, local recurrence, stage (according to 7th edition of American Joint Committee on Cancer TNM staging), differentiation, and site. Most patients (79 cases; 79%) were treated for primary cSCC, while the other 21 patients presented local recurrence of cSCC. Neck metastases were diagnosed in five patients with primary cSCC and in three with recurrent cSCC. No distant metastasis was observed. The most common tumour location was the auricle (29 cases; 29%). Neck dissection was performed most frequently in patients with lip tumours (17/22 cases; 77%). Neck metastasis was diagnosed most often in patients with cSCC on the lip (2 patients) and buccal region (2 patients). The most common tumour location in males was the auricle (25/66 cases; 38%) whereas in females the nasal and buccal regions were the most common locations, with 8 patients each (8/34 cases; 23%). Neck dissection was performed in 20 of the 66 males (30%) and in 12 of the 34 females (35%). Neck metastasis was confirmed in 5 females (15%) and 3 males (5%). The most common histopathological tumour stage was G2 (57 cases; 57%). Of the eight patients with confirmed neck metastasis, four had poorly-differentiated (histopathological stage G3). Thus, 4 of the 24 patients (17%) with stage G3 tumours experienced metastasis. Our findings suggest that factors such as local recurrence, degree of cell differentiation, tumour dimension and/or location, can increase the risk of neck metastases. For this reason, in patients with such risk factors, neck dissection should be considered to evaluate for metastatic lesions.

Uncontrolled human papilloma virus infection in a 28-year-old man leading to death - case report and review of literature.

Recurrent respiratory papillomatosis is an increasingly common disease which leads to organic and functional limitations. Clinical symptoms depend on the location and extent of the papillomatosis. They include hoarseness, cough, and, in some cases, significant narrowing of the respiratory and digestive tracts. The present report describes a fatal case of a young man (28 years old) who developed a very dynamic papilloma infection of the larynx, which spread to the trachea, the oesophagus, the soft tissues of the neck, and the mediastinum. Multimodal treatment did not stop the progression of the disease. The papillomatous lesion was removed with a CO2 laser used in a Kleinsasser microlaryngoscopy and under a microscope using a electrocoagulation loop with argon plasma during the gastroscopy. Antiviral treatment with cidofovir was introduced, as well as in further follow-up radiotherapy. Congenital or acquired immunodeficiency was also excluded. Despite multimodal treatment, successful eradication of the infection was not possible. In our case, aggressive progression of the disease was observed. We were unable to confirm malignant transformation. Papillomatosis was the only disease, and its aggressive development led to the patient's death. In the case of aggressive, uncontrolled progression - when the infiltration spreads beyond the larynx and the hypopharynx - there are no alternative treatment methods that would lead to an effective cure.

The role of selectins in alopecia areata.

INTRODUCTION: One of the main histopathological features of alopecia areata (AA) is a lymphocytic infiltration that surrounds hair follicles. Soluble forms of E, L, P-selectins are known indicators of ongoing inflammation. There are no studies regarding the assessment of their contribution in AA. AIM: To assess serum concentrations of selectins (E-selectin, L-selectin and P-selectin) in patients with AA in relation to selected clinical parameters, including disease severity and activity. MATERIAL AND METHODS: Sixty-four patients with AA were involved in the study. The diagnosis was based on physical examination and photodermoscopy. The control group consisted of 40 healthy subjects. The serum concentrations of soluble E-selectin, L-selectin and P-selectin were detected with ELISA method. RESULTS: Statistically significantly higher levels of E, P, L-selectins were found in AA patients as compared with the healthy group. Serum concentrations of soluble forms of E- and L-selectins correlated with the severity of the disease, while E-selectin with activity of AA. CONCLUSIONS: This study shows that selectins may play an important role in the pathogenesis of AA and may be a target of future therapies in this disease.

Delayed reconstruction of the upper digestive tract in a patient following total pharyngolaryngectomy with resection of the cervical oesophagus.

Carcinoma of the hypopharynx is an uncommon disease, with an annual incidence of approximately 1 in 100,000. Post-cricoid carcinoma is more common in women and is not usually associated with tobacco and alcohol abuse. Reconstruction of large pharyngeal defects following surgery for squamous cell carcinoma is complex and often requires microvascular free tissue transfer to achieve the best oncological and functional outcomes. The most common complications of such procedures include fistulas and strictures of the neopharynx. Here, we describe a case of a female patient admitted to the Head and Neck Department at our hospital to undergo delayed reconstruction following pharyngolaryngectomy and removal of the cervical oesophagus. Several complications occurred during post-operative care, including stricture and skin dehiscence. At present, the patient is able to swallow saliva and is currently being prepared to return to a normal diet.

The role of colour duplex sonography in preoperative perforator mapping of the anterolateral thigh flap.

The anterolateral thigh (ALT) flap was first described in 1984. It is now widely used in reconstructive surgery following extensive tumour resection in head and neck cancer. Routine preoperative perforator mapping is recommended due to variability of the vascular anatomy of the flap. A wide array of diagnostic tools is available for this purpose, including colour duplex sonography (CDS). In this study, we report our experience with CDS. The number, location, and course (myocutaneous or septocutaneous) of ALT perforators were assessed by CDS prior to reconstructive surgery in 22 patients with head and neck cancer. These data were compared with the intraoperative anatomical findings to assess agreement and reliability. The positive predictive value and sensitivity of CDS in detecting perforator location was 89.4 and 94.4%, respectively, when compared to the surgical report. CDS also identified the perforator course with 100% accuracy. Colour duplex sonography is an effective, non-invasive, and relatively inexpensive technique for assessing the location of skin perforators.

Oral cavity and oropharyngeal squamous cell carcinoma in young adults: a review of the literature.

BACKGROUND: Head and neck squamous cell carcinoma (HNSCC) is a disease of middle-aged to elderly adults. However, an increased incidence of HNSCC in young people under 45 years of age has been reported recently. In the present review, we focused on the epidemiology and aetiology of HNSCC in adults under 45 years of age. METHODS: We reviewed literature related to HNSCC in adult patients less than 45 years of age and discussed current treatment options and prognosis. RESULTS: HNSCC in young adults is associated with a higher incidence rate in nonsmokers, lower female-to-male ratio, a higher percentage of oral cavity and oropharynx tumours, and fewer second primary tumours. However, aside from traditional risk factors of tobacco and alcohol exposure, the causes of these cancers in young adults remain unclear. Agents that might contribute to risk include infection with high-risk human papillomavirus subtypes as well as genetic factors or immunodeficiency status. The expected increase in incidence and mortality of the young with HNSCC may become a major public health concern if current trends persist, particularly lifestyle habits that may contribute to this disease. CONCLUSIONS: Given the younger age and potential long-term adverse sequelae of traditional HNSCC treatments, young adults should be treated on a case-by-case basis and post-therapy quality of life must be considered in any treatment-decision making process.

Analysis of selected recurrence risk factors after treatment of head and neck basal cell carcinoma.

INTRODUCTION: Basal cell carcinoma (BCC) is the most common type of non-melanoma malignant skin tumors. Eighty-five percent of all cases are located on the skin of the head and neck. The risk of recurrence after surgery is estimated at 5-15%. AIM: To evaluate the selected risk factors for recurrence after surgical treatment of head and neck BCC at the Department of Head and Neck Surgery in the Greater Poland Cancer Centre of the Poznan University of Medical Sciences. MATERIAL AND METHODS: A retrospective analysis was made of patients treated at the Department of Head and Neck Surgery in the Greater Poland Cancer Centre of the Poznan University of Medical Sciences in 2007-2012 for BCC of the head and neck region. The study covered 312 patients: 198 males (63%) and 114 females (37%), aged 32-96 years. RESULTS: In the study group of 312 tumors, recurrence after initial treatment in this Centre was diagnosed in 18 patients (9%), whereas in patients who were previously operated elsewhere, recurrence was found in 22 cases (17%). The nodular type was the most common BCC type in the study group and concerned 175 patients (56%). The most numerous group (114; 37%) in this study group comprised patients with external nose and cheek tumors. CONCLUSIONS: The importance of preoperative biopsy to assess the histological type as a routine treatment of patients with BCC is essential. Ultrasound evaluation to assess the exact size and depth of tumor invasion should also be implemented.

Oral cancer in young adults: should we approach these patients differently?

Objective: The influence of age on treatment outcomes in oral cancer is unclear. We aimed to determine the prevalence of oral cancer in adults under age 45 and to compare treatment outcomes by age. Methods: Retrospective study of 284 patients treated for oral cancer from 2010 to 2021. The primary analysis involved the full cohort stratified by age (< vs. ≥ 45y). The second analysis included all patients under age 45 (n=44) matched 1:1 by sex and stage to older patients (age 55-70). Results: In the primary analysis, the only significant difference was more comorbidities in the older group (p<0.001). In the matched-pair analysis, older patients were more likely to be smokers (75% vs. 54%; p=0.045) and had more comorbidities (p=0.007). The mean PLR and NLR values were significantly higher in the younger group. Conclusions: No significant differences were observed between age groups in disease stage or outcomes, suggesting that other variables are more important.

A Matter of Margins in Oral Cancer-How Close Is Enough?

In patients with oral cancer, the risk factors for local, regional, and distant recurrence according to margin status have not been well established. We aimed to determine the risk factors for recurrence by margin status and to identify a margin cut-off point for improved survival in patients with close margins. We retrospectively reviewed adult patients treated at our centre from 2009 to 2021 for primary oral cancer. Margins were classified as positive (<1 mm), close (1 to 4.9 mm), or clear (>5 mm). Univariate and multivariate analyses were performed. A total of 326 patients (210 men) were included. The mean age was 59.1 years. Margin status was close (n = 168, 51.5%), clear (n = 83, 25.4%), or positive (n = 75, 23.0%). In the univariate analysis, positive surgical margins (HR = 7.53) had the greatest impact on distant failure. Positive surgical margins-without nodal involvement-had the greatest impact on the risk of distant failure. In the close margin group, the optimal cut-off for disease-free survival (AUC = 0.58) and overall survival (AUC = 0.63) was a deep margin > 3 mm, with survival outcomes that were comparable to the clear margin group. These finding suggest that margins < 5 mm may be sufficient in certain well-defined cases. Prospective studies are warranted to confirm these findings.