SAN FRANCISCO A 5-year local control rate is possible with or without skin excision in squamous cell carcinoma of the buccal mucosa, according to a retrospective study of 331 patients.
When patients are properly selected for skin preservation or sacrifice on the basis of surgical margins more or less than 1 cm, there are no statistically significant differences in survival, Dr. Chun-Ta Liao and colleagues reported. In patients treated with surgery alone, the 5-year survival rate was 94% with skin excision and 91% without skin excision. In patients treated with surgery plus adjuvant radiotherapy or chemotherapy, the 5-year survival rate was 82% with skin excision and 85% without skin excision.
While it's generally accepted that bone excisions are often indicated in this form of cancer, controversy remains, said Dr. Liao. Skin excision significantly affects the patient's appearance and may contribute to oral incompetence, so physicians prefer to preserve the cheek skin if doing so would not increase mortality.
The study, by Dr. Liao of Chang Gung University, Taoyuan, Taiwan, and colleagues, was presented at the Seventh International Conference on Head and Neck Cancer.
The investigators examined records from 331 patients with squamous cell carcinoma of the buccal mucosa. Of those, 149 received surgery alone and 182 received surgery followed by adjuvant radiotherapy or radiotherapy plus chemotherapy.
Patients received skin-preserving procedures when the distance between the tumor and the skin was 13 mm or greater. This was possible for 69.5% of the patients, Dr. Liao reported at the meeting sponsored by the American Head and Neck Society.
In another part of the study, the investigators determined that a surgical margin of 4 mm or below was an independent predictor of adverse outcome, leading to an 81% increase in the risk of local recurrence in patients receiving surgery alone and a 33% increase in risk in patients receiving surgery plus adjuvant therapy.
Dr. Liao said the investigators had no conflicts of interest regarding the study.