Faziale Hauttumore: Resektion und plastische Defektrekonstruktion – Teil 1

Zusammenfassung

Die Häufigkeit von Tumoren der Gesichtshaut nimmt aufgrund der steigenden UV-Exposition und der zunehmenden Alterung der Bevölkerung zu. Gleichzeitig steigen die Ansprüche an die Funktion und Ästhetik der rekonstruktiven Chirurgie im Gesicht. Die In-sano-Resektion mit Sicherheitsabstand ist der entscheidende erste Schritt eines operativen Vorgehens. Die anschließende Rekonstruktion ist von patientenspezifischen und weiteren Faktoren abhängig.

Abstract

Skin tumors are becoming more and more frequent due to an increased exposition to UV-radiation and the growing age of the population. At the same time expectations with regard to function and aesthetics are growing. An in-total resection of the tumor with clear margins is the first step in surgical treatment of such patients. Reconstruction of the resulting defects depends on patient-specific factors such as prior radiation therapy or prior surgery, the patient´s individual expectations and the surgeon´s skills. Local flaps are favorable in several respects, however they require a detailed plan and experience when being executed. The following article provides an overview of the most frequent facial skin tumors and the secure margins they require. Furthermore, it gives a general overview of the design of local flaps and grafts.

Schlüsselwörter

Gesichtshauttumor - Hauttumor - Rekonstruktion - Resektion - Lappenplastik

Key words

facial skin tumor - UV-radiation - surgical reconstruction - skin flap - skin graft

• Literatur

• 1 Loser C, Rompel R, Breuninger H. et al. Microscopically controlled surgery (MCS). J Dtsch Dermatol Ges 2010; 8: 920-925 doi: 10.1111/j.1610–0387.2010.07314.x
• 2 Lang BM, Balermpas P, Bauer A. et al. S2k-Leitlinie Basalzellkarzinom der Haut (Aktualisierung 2017/2018). Im Internet: www.awmf.org/uploads/tx_szleitlinien/032–021l_S2k_Basalzellkarzinom-der-Haut_2018–09_01.pdf
• 3 Telfer NR, Colver GB, Morton CA. et al. Guidelines for the management of basal cell carcinoma. Br J Dermatol 2008; 159: 35-48 doi: 10.1111/j.1365–2133.2008.08666.x
• 4 Bichakjian CK, Aasi SZ, Alam M. et al. Basal Cell Skin Cancer, Version 1.2019, NCCN Clinical Practice Guidelines in Oncology. 2018
• 5 Brantsch KD, Meisner C, Schonfisch B. et al. Analysis of risk factors determining prognosis of cutaneous squamous-cell carcinoma: a prospective study. Lancet Oncol 2008; 9: 713-720 doi:10.1016/S1470–2045(08)70178–5
• 6 Breuninger H, Eigentler T, Bootz F. et al. Plattenepithelkarzinom der Haut. AWMF Online 2013: 29
• 7 Criscione VD, Weinstock MA, Naylor MF. et al. Actinic keratoses: Natural history and risk of malignant transformation in the Veterans Affairs Topical Tretinoin Chemoprevention Trial. Cancer 2009; 115: 2523-2530 doi: 10.1002/cncr.24284
• 8 Marks R, Rennie G, Selwood TS. Malignant transformation of solar keratoses to squamous cell carcinoma. Lancet 1988; 1: 795-797
• 9 Breuninger H, Schaumburg-Lever G, Holzschuh J. et al. Desmoplastic squamous cell carcinoma of skin and vermilion surface: a highly malignant subtype of skin cancer. Cancer 1997; 79: 915-919
• 10 Breuninger H, Eigentler T, Bootz F. et al. Brief S2k guidelines--Cutaneous squamous cell carcinoma. J Dtsch Dermatol Ges 2013; 11 (Suppl. 03) 37-45 39–47. doi: 10.1111/ddg.12015_7
• 11 Brodland DG, Zitelli JA. Surgical margins for excision of primary cutaneous squamous cell carcinoma. J Am Acad Dermatol 1992; 27: 241-248
• 12 Stratigos A, Garbe C, Lebbe C. et al. Diagnosis and treatment of invasive squamous cell carcinoma of the skin: European consensus-based interdisciplinary guideline. Eur J Cancer 2015; 51: 1989-2007 doi: 10.1016/j.ejca.2015.06.110
• 13 Bichakjian CK, Aasi SZ, Alam M. et al. NCCN Guidelines Version 1.2019 Sqamous Cell Skin Cancer. 2018
• 14 Rowe DE, Carroll RJ, Day Jr CL. Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip. Implications for treatment modality selection. J Am Acad Dermatol 1992; 26: 976-990
• 15 Satzger I, Meier A, Zapf A. et al. Is there a therapeutic benefit of complete lymph node dissection in melanoma patients with low tumor burden in the sentinel node?. Melanoma Res 2014; 24: 454-461 doi: 10.1097/CMR.0000000000000081
• 16 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft DK, AWMF) Diagnostik, Therapie und Nachsorge des Melanoms, Langversion 3.1. In; 2018
• 17 Zitelli JA. Secondary intention healing: an alternative to surgical repair. Clin Dermatol 1984; 2: 92-106
• 18 Nordmann M, Veit J, Rotter N. et al. [Autologous composite grafts from the cavum conchae for reconstruction of multilayer nasal defects]. HNO 2016; 64: 288-291 doi: 10.1007/s00106–016–0126-x
• 19 Theissing J, Rettinger G, Werner J. Plastisch-rekonstruktive Gesichtschirurgie. In: Rettinger G, Hosemann W, Hüttenbrink K. et al., Hrsg. HNO-Operationslehre. 4. Aufl.. Stuttgart: Thieme; 2006
• 20 Weerda H. Kompendium plastisch-rekonstruktive Eingriffe im Gesichtsbereich. 4. Aufl.. Ethicon; 1992
• 21 Sadick H, Gassner H. Plastische Rekonstruktion einfacher und komplexer Nasendefekte. Laryngo-Rhino-Otologie 2017; 96: 628-652 doi: 10.1055/s-0043–104093