Head and neck skin involvement by non-cutaneous head and neck cancers: free flap reconstruction

Introduction: Patients with skin involvement from head and neck cancer have a poor prognosis, with a median survival time of 2 months. Method and results: During a 9 year period, 31 patients with skin involveme nt above the clavicle by non-cutaneous malignant tumours of the head and ne ck were treated. In 19 males and 12 females with a mean age of 62 years, th e parotid gland (32%) and the oral cavity (29%) were the commonest sites of primary disease and 77% of the cases were squamous cell carcinomas. Twenty -six had recurrent disease, 20 had received previous radiotherapy and all u nderwent surgical resection with free flap reconstruction, the commonest be ing the radial forearm (78%). Complete histological clearance was achieved in 53% of the cases, and adjuvant post-operative irradiation was given to 6 0%. With this form of management, palliation was extended to a mean survival of 13 months. Six patients are currently alive and disease free at a mean fol low up of 4.5 years. Conclusions: Patients with head and neck skin involvement by non-cutaneous head and neck malignancies have a very poor prognosis, but surgical resecti on combined with free microvascular flap reconstruction and planned postope rative radiotherapy, can offer good long-term palliation. (C) 2000 Harcourt Publishers Ltd.