Role of neck dissection in management of patients with clinically apparent parotid metastatic melanoma - systematic review.

Patients with cutaneous melanoma with metastatic deposits in the parotid gland have poor prognosis due to the high risk of developing distant metastasis. In the era of effective immunotherapy, there is no consensus amongst head and neck surgeons about the extent of neck dissection required for patients presenting with clinically apparent parotid metastasis. This review aims to determine the incidence and pattern of occult neck disease for patients with parotid metastasis reported in the literature to help guide clinicians on the extent of neck dissection required. The systematic review search was conducted using PubMed, EMBASE and Medline, using PRISMA guidelines. The inclusion criteria include cases treated with parotidectomy and neck dissection for patients with parotid melanoma metastasis. A narrative synthesis was carried out due to heterogeneity of studies. A total of 14 studies was included. We found no study reporting on outcomes with surgery and adjuvant immunotherapy in this cohort of patients. The incidence of distant metastasis reported was variable but remains high for patients with parotid metastasis. Patients with parotid and neck involvement have poorer prognosis than patients with parotid only metastatic disease. The effect and extent of neck dissection in patients with clinically apparent parotid nodes remains unclear in the era of effective immunotherapy. There is a need for further well-designed studies evaluating the outcomes for such patients following surgery and adjuvant immunotherapy.

Malignant transformation rate of erosive oral lichen planus: a retrospective study.

Oral lichen planus (OLP) is a chronic inflammatory oral condition previously known to have a rate of malignant transformation of around 1%. Additionally, erosive lichen planus, a subtype of lichen planus, which is a known risk factor for malignant transformation, has previously been unquantified in a large cohort of patients. In a single unit observation between 2005 and 2021 we retrospectively assessed 1,920 patients who underwent histological analysis for suspected oral lichen planus, and followed the progression of their disease to assess the rate of malignant transformation. In total, 1.39% of OLP transformed to oral squamous cell carcinoma over an average of 5.8 years. However, we found that the transformation rate of erosive OLP into malignancy was 5.98% with an aggressive clinical pathway. To our knowledge the incidence of erosive OLP has not previously been quantified in a large cohort of patients. This retrospective study sheds light on, and raises warning signs about, the seriousness of this condition.

Occupational exposure and risk of oral and oropharyngeal squamous cell carcinoma: systematic review and 25-year retrospective cohort study of patients.

Social habits such as smoking and drinking alcohol are well-known causative agents for oral and oropharyngeal squamous cell carcinoma (OSCC/OPSCC). Human papillomavirus (HPV) is a known causative agent for OPSCC. However, we often encounter patients with no identifiable risk factors. There is growing evidence of the role of occupational carcinogens in the pathogenesis of oral cancer. The aim of this study therefore was to identify any occupational carcinogens linked to oral cancer. We carried out a systematic review of the literature using PubMed, EMBASE, and Medline, along with a retrospective review of patients treated in a regional unit over 25 years. Occupations were classified based on the UK Standard of Classification 2020. Data analysis was completed using the chi-squared test. A total of 17 papers met the inclusion criteria for review. In our retrospective study a total of 874 patients were identified of whom 31% were blue-collar workers, 32.8% were white-collar workers, 20.2% were unemployed/housewives, and 16% workers in other occupations. The majority of blue-collar workers were in the construction industry and had maximum exposure to hydrocarbons and exhaust fumes. The aetiology of oral and oropharyngeal SCC is multifactorial and there is no consensus on the role of occupational carcinogens. We showcase our patient cohort and discuss the occupational exposures that appear to make them susceptible to OSCC and OPSCC. Further multicentre studies are required to enable us to understand fully the pathogenesis of oral cancer and help us to inform relevant organisations, the aim being to reduce the incidence of occupation-related cancer.

Adverse reactions associated with perioral rejuvenation using laser, fat and hyaluronic acid: systematic review.

Perioral rejuvenation is carried out by surgical and non-surgical tools. The common procedures are laser resurfacing and volumanisation using alloplastic fillers or autogenous fat. Nonetheless, any such procedures are associated with complications. To evaluate a concise presentation of complications and safety associated with different perioral rejuvenation treatments including laser ablation, fat grafting and hyaluronic acid injections. A systematic literature review of all the relevant studies and case reports on complications and adverse reactions associated with laser ablation, administration of fillers and fat for the rejuvenation of perioral region. Twelve articles passed the inclusion criteria (as per PRISMA guidelines) and were scrupulously analysed. Four publications evaluated complications associated with laser resurfacing, five were related to filler augmentation and three were related to fat administration. The results concluded that all three aesthetic treatments are associated with mild to moderate complications. Severe complications are rare but can arise. Clinicians should be mindful of possible complications and able to recognise adverse events so that remedies could be executed with minimal delay. Training and supervision are essential components of ensuring provision of safe aesthetic treatment, and lack of regulation is a concern.

Recent advances in the management of cutaneous malignant melanoma: our case cohort.

Decades of research into the management of cutaneous malignant melanoma have proven it to be a 'tough nut to crack', and its incidence has continued to increase over the last 30 years. Surgery remains a gold standard for early-stage melanoma with five-year survival of 98% for stage I disease, and 90% for stage II. Nonetheless, patients with stage III disease are at a higher risk, resulting in local recurrence as well as distant metastasis. Research regarding the control of metastatic malignant melanoma of the head and neck has evolved. Currently the search is on to understand metastatic malignant melanoma as a heterogeneous disease both at the molecular and clinical level. This paper focuses on the latest systemic therapy for metastatic disease of the head and neck, including cytotoxic chemotherapy, immunotherapy, and target therapy. The new eighth edition of tumour staging, and the sequelae for malignant melanoma, sentinel lymph node biopsy (SLNB), surgical intervention, and its benefits and shortfalls, are discussed. Also, the outcome of our cohort series of patients with metastatic cutaneous malignant melanoma who were treated with systemic combination therapy in Dorset is presented.

Evolution of surgical modalities in the management of rhinophyma: our experience.

Rhinophyma is a progressive disease of the nose, which is characterised by skin thickening and sebaceous hyperplasia. Patients with rhinophyma are often stigmatised due to worsening disfigurement of their nose. This can also result in functional impairment such as reduced nasal patency. Severe cases of rhinophyma are best managed with varied surgical interventions, as there is no clear 'gold standard' treatment that has been described. We present our experiences in the management of rhinophyma and the evolution of treatment modalities that have been employed over a nine-year period.

Importance of anatomical site in the metastases of auricular cutaneous squamous cell carcinoma: an observational study.

Malignancies of the auricular skin tend to metastasise to preauricular, parotid, facial, and level II (possibly to levels IV and V) lymph nodes in an unpredictable manner. Over the years, we have observed that this pattern of metastasis is commonly linked to lesions that involve the lower half of the ear. To find conclusive evidence based on this hypothetical observation, we retrospectively studied 108 patients who presented with squamous cell carcinoma (SCC) of the ear, and looked at the exact auricular site of the lesion at presentation, incidence of metastasis, nodal involvement, treatment, and survival outcome. The literature was reviewed extensively to ensure detailed presentation of the lymphatic drainage pathway. The pattern of spread and outcome were evaluated. This study has shown that there is a significant correlation between anatomical position and risk of metastasis, and that lesions of the lower half of the ear are more prone to metastasis. These patients therefore may warrant early imaging, possible sentinel node biopsy, or even selective neck dissection with simultaneous primary excision.

Outcome of eminectomy combined with discectomy and silastic interpositional graft for temporomandibular joint dysfunction: a retrospective study of 20 years.

Internal derangement of the temporomandibular joint (TMJ) is usually treated conservatively, but about 5% require surgical treatment. We designed a retrospective study to assess the long-term outcomes of eminectomy combined with discectomy and silastic interpositional graft in 44 patients who had chronic TMJ dysfunction that had not responded to traditional conservative treatment and arthrocentesis. The maximum mouth opening, pain score, Wilkes stage, and clinical dysfunction index were measured before, and two years after, operation. All the patients showed significant improvement in mouth opening and reduced pain scores (p<0.0001 in each case). There were no long-term operative complications, and postoperative magnetic resonance scans showed that the silastic interpositional graft was in a stable position with no evidence of degenerative changes on the surfaces of the joint and no lymphadenopathy.

WITHDRAWN: Re: Management of seborrhoeic keratosis and actinic keratosis with an erbium: Yag laser-experience with 547 patients.

This letter has been superseded by the retraction (http://dx.doi.org/10.1016/j.ijom.2020.01.023) of the original article and has therefore been withdrawn. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Evolution in the management of oropharyngeal squamous cell carcinoma: systematic review of outcomes over the last 25 years.

The treatment of oropharyngeal squamous cell carcinoma (SCC) has evolved over the last 25years, from open surgery to combined chemoradiotherapy, and now to the development of minimally invasive procedures, but evidence for the best treatment is lacking. We therefore did a systematic search of the MEDLINE database for studies published between 1992 and 2017 that reported oncological or functional outcomes, or both. Predefined inclusion and exclusion criteria were used for screening and selection, and 45 studies were chosen. Only one was a randomised controlled trial, all the rest were prospective or retrospective case series. The heterogeneities in their characteristics made meta-analysis impossible and only qualitative analysis was feasible. We found no conclusive evidence to suggest the advantage of one therapeutic approach over another, so we still cannot offer patients the "ideal" treatment. We have, however, raised the possibility of there being two different entities: human papillomavirus (HPV)-positive and HPV-negative disease.

RETRACTED: Management of seborrhoeic keratosis and actinic keratosis with an erbium:YAG laser-experience with 547 patients.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Editors because the photograph in Figure 1b was a duplicate image of Figure 1a, but with the keratosis removed, and did not represent the surgery that was described in the article. The authors apologise for this error.

Sensory recovery of noninnervated free flap in oral and oropharyngeal reconstruction.

The sensory recovery of noninnervated free flaps used in oral and oropharyngeal reconstruction is analysed retrospectively to evaluate the degree of sensory recovery in different free flaps; and to assess the influence of various clinical and surgical factors on the recovery. A total of 40 patients who underwent oral and oropharyngeal reconstruction with noninnervated radial forearm (24), jejunal (10) or gastro-omental (6) free flaps were studied for at least 12 months postoperatively. The modalities examined were light touch, sharp prick, hot and cold temperature and static two-point discrimination. All the modalities showed statistically significant recovery in all flaps (p<0.05). The degree of sensory recovery for each modality is highest in the radial forearm followed by gastro-omental and lastly jejunal flaps. The differences between radial forearm and gastro-omental/jejunal flaps are statistically significant (p<0.05) except for light touch. The differences between the later two groups of flaps did not show statistical significance (p>0.05). Sensory recovery for all modalities in all flaps was not dependent on sex, age, smoking, flap size, postoperative radiotherapy or follow-up period (p>0.05).

Revisiting lip shave: a solution for disorders of the vermilion border.

Actinic keratosis, leukoplakia, carcinoma in situ, and superficially invasive carcinomas of the lower lip are caused mainly by the cumulative effects of exposure of the vermilion of the lower lip to ultraviolet radiation. Current treatments all have limitations: cryosurgery or electrosurgery is suitable to treat only focal lesions; topical chemotherapy, which is an option for diffuse actinic damage, yields unreliable results; and laser treatment fails to rejuvenate the vermilion. However, "lip shave", which involves full-thickness excision of the damaged vermilion and reconstruction with an advancement labial mucosal flap, will produce a fresh mucosal lining to the vermilion border. We describe our experience of the technique and evaluate the functional and aesthetic outcomes in 20 patients treated between January 2011 and January 2016. The follow-up period ranged from 24 to 60 months. Three-quarters of the patients had dysplasia or superficially invasive malignancy. Resected lesions were about 63mm long, 13.7mm wide, and 3.9mm deep. No patients had recurrence or secondary lesions during follow up, functional disturbance was minimal, and the cosmetic outcome pleasing. Lip shave can efficiently reconstruct the vermilion of the lower lip with minimum deformity.

Epidemiology of basal cell carcinoma: a 10-year comparative study.

Basal cell carcinoma (BCC) is a slow-growing and locally aggressive skin cancer. Despite its high incidence, good quality epidemiological data are sparse. We therefore organised a retrospective study of two separate years' incidence of BCC in one county within the United Kingdom (Dorset) with an interval of 10 years between them. There were 2455 patients in 2006, and 3797 in 2016, who had a new diagnosis with corresponding crude incidences of 459.99 and 491.92/100,000 person-years. The male:female ratio was 1:071 for both years. The head and neck was the most common site, with the cheek, nose, and forehead being the most common subsites. This is a substantial increase in the incidence of BCC, and is much higher than previous reported rates for the UK. More stringent local and national registries are required to monitor the increasing numbers of BCC and help health care systems to plan preventive strategies and provide the most effective treatment.

Percutaneous treatment of orofacial vascular malformations.

The aim of this study was to evaluate the efficacy of fluoroscopy-guided percutaneous injection of bleomycin as the primary treatment for low-flow vascular malformations. A total of 34 patients (mean (range) age 24 (8-51) years) with orofacial vascular lesions were treated in the Department of Interventional Radiology and Maxillofacial Surgery. There were 20 low-flow venous malformations, 11 lymphatic malformations, and three of mixed type. All patients were treated by fluoroscopy-guided percutaneous injection of a mixture of bleomycin (mean (range) 15 (5-15)mg) and a radio-opaque agent (Ultravist® (iopromide), Bayer)/session. The number of sessions ranged from one to six. The clinical response was complete in 21 patients, obvious in nine, and of clinical benefit in four. Patients were reviewed within the first week, third week, and at three-month periods until 24 months. There were no serious complications such as pulmonary fibrosis. Fluoroscopy-guided intralesional injection of bleomycin should be considered as the first-line treatment for lymphatic malformations because it is effective and reliable with few complications.

Dyskeratosis congenita: its connections with oral and maxillofacial surgery.

Dyskeratosis congenita is characterised by abnormal pigmentation of skin, dystrophy of nails, and mucosal leukoplakia mainly on the tongue. Bone marrow failure, pulmonary complication, and premalignant leukoplakia of the tongue are serious complications of the disease.

Epstein-Barr-virus-related mucocutaneous ulceration that mimics oral squamous cell carcinoma: the importance of recognising this new condition.

We report a case and present a literature search of the relatively newly reported condition of Epstein Barr Virus (EBV)-related mucocutaneous ulceration. EBV-related mucocutaneous ulcers clinically present as oral squamous cell carcinoma (OSCC) in immunocompromised elderly patients but usually resolve by stopping or modifying the medication. As the two conditions can present in a similar way, and the management of each is totally different, this case highlights the importance of recognising this condition at an early stage.

Minimally-invasive neck dissection and free flap reconstruction in patients with cancer of the head and neck.

We describe our experience of cervical lymphadenectomy with microvascular anastomoses involving levels I to V through a minimally-invasive neck dissection. We retrospectively studied 12 patients who had levels I to IV neck dissection with free flap reconstruction between July 2013 and April 2015 at Poole Hospital (male:female ratio 8:4, mean (range) age 66 (49 - 83) years). The mean (range) operating time was 7 (5 - 8) hours, and the total volume drained from the neck was 105 (60-300) ml. The mean (range) number of harvested lymph nodes was 26 (13-39) from levels I to III, and 33 (20-42) from levels I to IV. Four patients developed weakness of the marginal mandibular nerve, but there were no serious complications. All flaps were successful, there was no regional recurrence, and most patients were discharged on postoperative day 15. This technique provides adequate exposure for lymphadenectomy and anastomosis, and we think that head and neck surgeons should include it in the armamentarium of reconstruction.

Squamous cell carcinoma of the anterior tongue: is tumour thickness an indicator for cervical metastasis?

The incidence of squamous cell carcinoma (SCC) of the tongue accounts for 90% of all malignancies affecting the oral cavity and oropharynx. The distribution between the anterior and posterior tongue is equal. Nodal metastasis is dependent on various factors including tumour thickness, site, size, differentiation, and perineural and perivascular invasion. There is increasing evidence of a close correlation between tumour thickness and metastasis. A retrospective study covering the 16-year period from 2000 to 2016 was performed. Eighty-one patients with anterior tongue SCC were included. The only primary treatment was surgery. All patients were T1/T2N0M0 stage. Sixty-five patients underwent local excision with simultaneous selective neck dissection; 29 of these patients were confirmed to have occult metastasis. Sixteen patients underwent local excision only as an initial treatment. Four of them subsequently developed neck metastasis within a 6- to 18-month period. The results of this study support recent publications associating tumour thickness with nodal disease. Therefore, it is postulated that prophylactic neck dissection should be considered when the tumour thickness of anterior tongue SCC exceeds 5mm, in order to prevent lymphatic spread and improve the survival rate.