Surgical Management of Nonmelanoma Skin Cancers Involving the Skull Base

Background/Objectives: A relative paucity of information exists on the outcomes from craniofacial resection for advanced nonmelanoma skin cancers involving the skull base. We reviewed our surgical experience to determine disease control rates, overall survival, morbidity and mortality.

Methods: A retrospective review of twenty-four patients with nonmelanoma cutaneous cancers with skull base involvement treated surgically at The University of Texas MD Anderson Cancer Center from 1994 - 2012 was performed. Of these patients, 79% had squamous cell carcinoma, 17% had basal cell carcinoma and 4% had adenoid cystic carcinoma. Factors such as prior treatments, TNM staging, tumor involvement, extent of intracranial extension, margin status, post-operative complications, recurrence, disease status at last follow-up and long term survival were assessed.

Results: Fifteen patients had prior treatment at a median of 9.1 months prior to presentation at MDACC. A majority of tumors were T4 (67%) with involvement of the orbit (54%), anterior fossa (42%), middle fossa (71%), petrous temporal bone (25%). Perineural extension was noted in 58% cavernous sinus involvement in 25%, dural involvement in 29%. As part of their resection, 54% required radical orbitectomy and 25% underwent a lateral skull base resection. Gross total resection was achieved in 96%; 63% with negative margins and 33% with positive margins. Post-operative complications occurred in 20% with 1 patient mortality. With a median follow-up of 85 months, the mean OS was 81 months and mean PFS was 69 months. At last follow-up 16 patients (67%) were NED; 7 patients died of disease and 12 died of other causes.

Conclusions: Aggressive surgical resection for advanced nonmelanoma skin cancer with skull base involvement can be performed with minimal morbidity/mortality. Improved OS and PFS can be expected even in light of perineural or cavernous sinus involvement. As these patients often have few options, craniofacial resection is justified if it can be performed safely.