Published in:
01-04-2015 | Original Paper
Cause of death among head and neck skin cancer patients in a Nigerian hospital: significance of the cranium
Published in: European Journal of Plastic Surgery | Issue 2/2015
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Background
Most cancers in the head and neck region spread locally. This study was designed to evaluate the involvement of the cranium in cause of death among head and neck skin cancer patients.
Methods
All cases of skin malignancy appearing in the head and neck region were documented. Cause of death was noted for all deceased head and neck skin cancer patients. Cranial involvement, or not, was recorded in each case. Recurrent lesions, types of previous treatment, if any, and cranial perforation, when present, were documented.
Results
One hundred thirty-one patients were seen. One hundred eighteen (90.1 %) had lesions involving the cranium. Thirty-four head and neck cancer patients died during study period. Thirty-two (94.1 %) died as a result of local spread of disease to the brain through the cranium. Recurrent and persistent lesions were accounted for 35 (26.7 %) cases; out of which, 18 (13.7 %) had been excised and wound was immediately closed directly; 10 (7.6 %) had been excised and wound immediately primarily closed using vascularized free flaps. Five (3.8 %) had previously been managed solely with radiotherapy. Two (1.5 %) applied 5FU ointment on prescription for basal cell carcinoma, which transmuted to squamous cell carcinoma. Eleven (8.4 %) referral cases with cranial perforation presented after recurrence.
Conclusions
Deaths that were caused by spread of cancer to the brain through the cranium were 94.1 %. Radiotherapists should be educated on the grave danger of causing osteoradionecrosis of the cranium. The value of medical remedies for malignancies around the cranium should be properly reevaluated. Surgery appears to be the favoured therapy for cranium-involved skin cancer.
Level of Evidence: Level IV, risk / prognostic study