Das Basalzellkarzinom der Nase - Klinik und histologische Behandlungsergebnisse von 222 ambulant operierten Tumoren einer mund-kiefer-gesichtschirurgischen Praxis im Zeitraum 2012-2015

Ziel der vorliegenden Arbeit war es, operativ entfernte Basalzellkarzinome im Zeitraum von Januar 2012 bis einschließlich Dezember 2015 einer ambulant tätigen mund-, kiefer - und gesichtschirurgischen Praxis zu untersuchen. In der retrospektiven Untersuchung von 222 kurativ operierten Basalzellkarzi...

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Bibliographic Details
Main Author: Rupenthal, Hannah
Contributors: Neff, Andreas (Prof. Dr. med. Dr. med. dent.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2019
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The aim of this study was to investigate basal cell carcinomas surgically re-moved in an oral and maxillofacial surgery outpatient practice between January 2012 and December 2015 inclusive. In the retrospective study of 222 basal cell carcinomas that underwent curative surgery the localisation, or the nasal area, resection outcomes (R0/R1), subtypes, sex, comorbidities, surgical method and procedure and any complications that developed were analysed. There are numerous clinical studies in the current literature. This study presents localisation-specific outcomes from an outpatient practice for the first time. It can be shown that outpatient practices are the equal of hospitals in regards to their outcomes for the spectrum of outpatient treatments. The methodology for the present study involved gathering the required infor-mation from the medical history forms, surgical reports, histology reports and the hospital files. The information obtained from these sources was tabulated and underwent statistical analysis with the R analytical tool. The results of this analysis were compared to national and international clinical studies. The evaluation revealed a mean age of 69.2 years; this confirms that basal cell carcinoma is predominantly a disease that affects the older generation. Men and women were equally affected. The doctors who most commonly referred patients with cancer to the practice were general practitioners in 70.7% of cases (n=157). In 48.2% of cases (n=107), there was an externally verified histologi-cal diagnosis and in 40.1% of cases there was none (n=89). In a further 11.7% of cases a biopsy sample had been collected by the practice itself (n=26). The ala of the nose were affected most commonly compared to other regions on the nose. Regarding the BCC subtypes, a solid basal cell carcinoma was removed signifi-cantly more often (77.0% with n=171). Sclerodermiform and superficial basal cell carcinoma occurred in 13.1% (n=29) and 9.5% (n=21) of cases respectively in the outpatient study population that was investigated. 39.2% of those treat-ed took an anticoagulant (n=87). Nevertheless, complications only occurred in 6.9% of the operations (n= 15). The rate of complications across all operated basal cell carcinomas was 5% (n=11). The proportion of surgically removed basal cell carcinoma in which there was a comorbidity was 37.9% (n=81). The therapy method was always surgical excision. The wound was closed im-mediately in 74.8% (n=166) of cases. The two-stage method used for 12.2% (n=27) of cases involved defect coverage in a second operation. In 5.4% (n=27) of cases open granulation occurred after excision and in 7.7% (n=17) of cases there was a reduction in the defect. 81.5% (n=181) of the tumours had a hori-zontal tumour diameter of up to 15 mm with only 3.2% (n=6) of cases having a tumour diameter greater than 15 mm (15.3% with n=34 no information availa-ble). The defects were most commonly closed using local advancement flaps with 57.2% (n=127). Wound closure with pedicle flaps was used in 27.9% (n=62) of cases with open granulation used in 3.6% (n=8) of cases. A full-thickness skin graft was used for 3.6% (n=8) of patients. A complete resection was achieved in 89.2% (n=198) of the operated basal cell carcinomas. An incomplete resec-tion occurred in 10.8% (n=24) of the cases. Various factors that were investigated correlated with the incomplete resec-tions. This includes the presence of a biopsy sample, the size of the tumour, the localisation on the nose and the subtype. On the basis of the current data it is suspected that there is a statistically insig-nificant relationship between the presence of a biopsy sample and the occur-rence of R0 and R1. The distribution of the subtypes for the R1 resections was proportional to the frequency distribution of the subtypes. A relationship be-tween the size of the tumour and the R0/R1 resection was found. The use of an anticoagulant medication did not have any effect on the frequency of compli-cations. The surgical procedure and the frequency of R0/R1 resections are statistically dependent. Resection and subsequent two-stage coverage correlated with a significantly higher frequency of R1 resections. There is a statistically con-firmed relationship but no causal relationship. This can be explained by the fact that the surgical methodology depends on factors such as the subtype and the size of the tumour, which in turn increases the likelihood of R1 if it involves a large tumour or a tumour with ill-defined margins. This explains why the likeli-hood of R1 increases for the two-stage procedure. Patients with basal cell carcinoma of the nose can thus be treated nearby, as outpatients and with adequate medical care. There are, however, limits for out-patient treatment that must be adhered to. For a tumour greater than about 25 mm in size or with infiltration of adjacent structures such as the bone or carti-lage, treatment in an inpatient setting is recommended as appropriate. Not least of all there is an economic advantage for outpatient treatment of patients. However, this was not the subject of the current study and could be investigat-ed in a further study.