Management of oral squamous cell carcinoma treated with inadequate excisional biopsy

Purpose: When an initial "excisional biopsy" has been performed on a primar y oral carcinoma, microscopic tumor may remain and the usual landmarks that enable the surgeon to plan his safe margin are destroyed. This article ana lyzes the impact that such a biopsy may have on treatment and patient outco me. Patients and Methods: A retrospective chart review of a consecutive series of 350 oral cancer patients treated by 1 surgeon in an 8-year period identi fied 33 (9.4%) patients who originally had inadequate excisional biopsies. Exclusion criteria eliminated 7 patients who were lost to follow-up or who had undergone previous treatment with radiation therapy or chemotherapy. Da ta extracted included age, sex, race, primary intraoral site, estimated tum or (T) stage, method of treatment, histology, follow-up, and outcome. Results: Twenty-four of the 26 patients underwent re-excision of their oral cancer. Ten of these patients (38.4%) also underwent selective neck dissec tion. Fifteen of the 24 patients (62.5%) had residual carcinoma identified in the re-excision specimen, and 3 of the patients who underwent elective n eck dissection had micrometastasis identified. The patients were followed f or an average of 35.5 months. Two of 24 (8.3%) patients had local recurrenc e at 36 and 84 months, respectively. Both patients were managed with re-exc ision and are still alive with no evidence of disease. Of the 10 patients o riginally treated with elective neck dissection, there has been no regional recurrence. However, of the 14 patients who underwent re-excision of the l esion without neck dissection, 3 developed regional disease at 1, 5, and 6 months, respectively, postoperatively. These patients underwent neck dissec tion and radiation therapy. Two patients are alive with no evidence of dise ase, and the third died of a second primary lung cancer. Twenty-five of the 26 patients (96.2%) are still alive and well with no evidence of disease. Conclusions: Patients who have had inadequate excisional biopsies can be ef fectively managed with re-excision plus neck dissection when indicated by T stage or more than 3 mm depth of invasion. (C) 2001 American Association o f Oral and Maxillofacial Surgeons.