Objectives/Hypothesis: We reviewed our experience with craniofacial resection for advanced, nonmelanoma
skin cancer of the head and neck to determine prognostic factors, local control rate,
disease free survival, morbidity, and mortality.
Study Design: Retrospective review of consecutive patients treated at a tertiary referral center
from 1982 to 1993.
Methods: Charts of patients having craniofacial resection for aggressive nonmelanoma cutaneous
malignancies were reviewed and living patients followed for 10 additional years. Demographics,
histology, previous interventions, treatment, surgical pathology, reconstructions,
and complications were examined. The product-limit method was used to calculate survival
functions, and the log-rank test was used to compare survival distributions.
Results: Thirty-five patients, mean age 66.7 years, received treatment at our facility. Follow-up
ranged from 2 to 191 (mean 47.4) months. Histology included 20 squamous cell carcinomas
(SCC) and 15 basal cell carcinomas (BCC). Sixty percent had craniofacial resection
alone, and 28.6% also had postoperative radiotherapy. There were two perioperative
deaths, and 37.1% suffered early and 14.3% late surgical complications. Two- and five-
year survival was significantly better (P = .02) with BCC (92% and 76%) than with
SCC (54% and 24%). Long-term disease-specific survival was 20%, and 11.4% of our subjects
were living with disease. Intracranial extension (P = .02), perineural invasion (P
= .049), and prior radiotherapy significantly decreased 5-year survival.
Conclusions: Acceptable mortality and morbidity is possible using craniofacial resection to treat
advanced nonmelanoma skin cancer. Although disease-specific survival remains poor,
positive trends were noted in local control beginning at 2 years of follow-up. Because
patients often have few remaining options for cure, craniofacial resection is justified
when technically feasible.
