Arch Otorhinolaryngol 227, 397-402 (Kongregbericht 1980) �9 Springer-Verlag 1980

R u n d t i s c h g e s p r f i c h I

Bew~ihrte Nahlappenplastiken bei der operativen Behandlung von Gesichtshautmalignomen

Moderator: E. Haas, Karlsruhe

E i n l e i t e n d e R e f e r a t e

E. Haas (Karlsruhe): Grundlagen der operativen Behandlung von Gesichts- hautmalignomen*

Principles of the Surgical Treatment of Malignoma in the Facial Area

Summary. The complete mastery of reconstructive plastic surgery is a basic requirement first essential for sufficient radical treatment of basal cell carcinoma in the facial area.

Furthermore, the subclinical growth of the basal cell carcinoma must be taken into consideration. One can assume that the growth of the b.c.c, is much greater than the apparent clinical limits, especially in cases of recurrent tumors, tumors of long standing, tumors in frontal and temporal regions, as well as tumors with diameters of more than 2 cm and scleroderm growth. In such cases a safety margin of 8-15 mm is required, whereas by primary and locally well defined b.c.c, a safety margin of 3 - 5 mm is regarded as sufficient.

Following the examination of the microscopically controlled surgery developed by MOHS, which is suitable for improvement of the five-year cure rate after surgical treatment of b.c.c., the treatment of the squamous cell carcinoma of the bottom lip is dealt with. Taking into account the tendency of these tumors to metastasise, it is advised to carry out an elective neck-dissection confined to the supra-hyoidal region in cases of squamous cell carcinoma in the stages T2 and T3 and also by suspicious metastastical changes in the lymphnodes.

The diagnosis of a malignant melanoma is fundamentally histological. The tumors is electrically excised with a clearance safety margin of surrounding skin of 1 cm if clinically there appears to be a 10% likelihood of the tumor being a malignant melanoma. If the histological frozen section of

* Erscheint ausffihrlich in Z. Laryngol. Rhinol. Otol.