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+++++++++++++++++++++++++++++++++ + + +++++++++++++++++++++++++++++++++ SPECIAL SECTION: CANCER +++ +++ Cancer Skin By Vasu Pandrangi, MD N ONMELANOMA CANCERS SUCH as basal cell carcinoma and squamous cell carcinoma are the most common tumors among white Americans commonly affecting the head and neck. They present as erythematous lesions to a tan papule to deep ulcers. The biological behavior is quite variable from slow growth to metastasis. Basal cell cancer was first described in 1827 by Jacob as rodent ulcer. Basal cell carcinoma originates in pluripotential epithelial cells of the epidermis and hair follicles with a cell cycle that is one cell to become two in nine days. Periorbital, perinasal and periauricular regions tend to have high recurrence rates because of difficulty in assessing their complete removal histologically. Nevus Sebaceous, Porokeratosis and Actinic Keratosis are predispos- ing lesions. Histologically, basal cell carcinomas are cartilaginous as super- ficial, nodular, nodular-ulcerative, ulcerative, infiltrative and morphea like. Morphea like, or sclerosing basal cell carcinoma, show proclivity for large subclinical extensions. Basal Cell Nevus Syndrome (Gorlin's) is associated with multiple scattered basal cell carcinomas with bony abnor- malities such as jaw cysts and scoliosis. Xeroderma Pigmentosum is character- ized by intolerance to ultraviolet light thus resulting in premature aging of the skin and multiple epithelial neoplasms. Metastatic basal cell cancers are extremely uncommon. An 86-year-old man with loss of nasal lining, cartilaginous framework and skin and subcutaneous tissue. The internal lining was reestablished by using a median forehead flap. The cartilaginous framework was built by using the septal cartilage. The soft tissue defect was resurfaced using a large scalping flap. The scalp defect resulted because of the rotation of the flap and was repaired with a split-thickness skin graft in stage one. Squamous cell cancers have a general growth rate of two days and are strongly linked to sun exposure. These tumors that develop in immunosuppressed patients are highly aggressive. The prognosis for squamous cell carcinoma depends on the degree of cellular differentiation and perineural invasion. The treatment options for non- melanotic malignancies encompasses curettage, electrodesiccation, cryo- surgery, chemotherapy, radiation, and surgical excision, which also includes Mohs, micrographic surgery that was developed by Frederick Mohs in 1932 with zinc chloride as fixative. The Mohs technique was widely accepted in 1970 with Tromovitch's technique of fresh tissue resection. Surgical excision with the tumor free margin is the time honored treatment of 18 | Cleveland/Akron/Canton MD NEWS s MDNEWS.COM s NOVEMBER-DECEMBER 2012 choice with cure rates of 85-95%. Basal cell carcinomas are much more likely to recur in young women because of excision with conservative margins. The recurrence rates relating to scalp, ear and eye areas tend to be higher for the same reason. Many of our elderly populations present themselves with multiple and on occasion recurrent basal cells and some- times with a squamous cell component embedded in the tumor. Obviously, recur- rent and aggressive tumors require Mohs technique. The two cases depicted here present complex problems which require multistage procedures to achieve accept- able functional and aesthetic results. Dr. Vasu Pandrangi is a board-certified plastic surgeon on the Medical Staf f at Southwest General, and chairman, Southwest Community Health System Board of Trustees. s PHOTOS COURTESY OF VASU PANDRANGI, MD