Acta Dermato-Venereologica 99-13CompleteContent | Page 14

1246 CLINICAL REPORT Electrochemotherapy in Skin Malignancies of Head and Neck Cancer Patients: Clinical Efficacy and Aesthetic Benefits Antonio BONADIES 1 , Ettore BERTOZZI 1 , Renzo CRISTIANI 1 , Flavio A. GOVONI 2 and Emilia MIGLIANO 1 Department of Plastic and Reconstructive Surgery, San Gallicano Dermatological Institute, IRCCS, and 2 Department of Maxillofacial Surgery, San Camillo-Forlanini Hospital, Rome, Italy 1 Skin malignancies of the head and neck inflict signi­ ficant structural, functional, and cosmetic burdens upon those affected. We retrospectively addressed electrochemotherapy anti-tumour efficacy in head and neck skin cancer patients who were not suitable for standard treatments. Scars’ physical characteristics and aesthetics were evaluated using validated scar assessment scales. Among 33 treated patients, 82% experienced a complete tumour response while 18% experienced a partial response. At a median time pe­ riod of 7 months, 96% of the evaluated scars came close to resembling the normal surrounding skin sho­ wing excellent results in terms of restoration to origi­ nal condition with no deformity and/or distortion and in terms of preservation of functionality, such as oral competence and eye protection. Electrochemotherapy is an effective local anticancer procedure for cuta­ neous tumours. In the treatment of skin malignancies of the head and neck, especially in non-surgical cases, in the elderly and in patients declining surgery, elec­ trochemotherapy may represent a valid alternative to standard management. Key words: electrochemotherapy; head and neck skin cancer; quality of life; aesthetics; cosmetic outcome; scar assessment scale. Accepted Oct 14, 2019; E-published Oct 14, 2019 Acta Derm Venereol 2019; 99: 1246–1252. Corr: Antonio Bonadies. Department of Plastic and Reconstructive Sur- gery, San Gallicano Dermatological Institute, IRCCS, Via Elio Chianesi, 53, IT-00144 Rome, Italy. E-mail: [email protected] S kin malignancies (SM) of the head and neck (HN) area inflict significant structural, functional, and cosmetic burdens upon those affected. Surgical excision is the most common method of treatment for SM of the HN. The main objectives of anticancer treatments are the total removal of the tumour and patient survival, yet the patient’s func­tionality and self-esteem preservation are becoming such that they are starting to be considered as essential goals. Electrochemotherapy (ECT) is a safe, well established, local tumour ablation procedure that is effective on so- lid tumours (1, 2). It combines the local application of electric pulses (electropermeabilization) and low dosage chemotherapy in order to facilitate the delivery into the tumour cell of otherwise non-permeant anticancer drugs thus leading to a dramatic increase in local cytotoxicity doi: 10.2340/00015555-3341 Acta Derm Venereol 2019; 99: 1246–1252 SIGNIFICANCE The main goal of skin cancer treatments is to eradicate the tumour with the safest method providing an aesthetically and functionally pleasant outcome. Electrochemotherapy is a minimal-invasive local tumour ablation procedure for cutaneous metastases. This study found that in head and neck skin cancer patients treated with electrochemothera- py, after tumour clearance and wound healing, most of the assessed scars showed physical and aesthetic characteris- tics very similar to those of normal surrounding area. These results suggest that in the management of head and neck skin cancer, electrochemotherapy may represent a valid al- ternative to traditional techniques when such techniques are not suitable. (3). ECT has proven highly effective for the treatment of cutaneous and subcutaneous tumours, regardless of their histological origin (4, 5). ECT also has an effect on the control of bleeding due to metastatic tumour deposits and mass-related symptoms (6). An increasing number of studies have provided evi- dence for the efficacy of ECT in various types of skin tumours located in the head and neck region. Treatment with ECT is suitable in advanced primary or recurrent or metastatic basal cell carcinoma (BCC), squamous cell carcinoma and in cutaneous metastases of melanoma of the head and neck. (7–9). It is effective in previously irradiated areas where chemo-radiation protocols can be inapplicable (10, 11). Because of its selectivity towards dividing tumour cells, when treating safety margins to decrease the risk of recurrence, it spares normal healthy tissue that surround the tumour and preserves organ functions (12, 13). This is particularly important in BCC with ill-defined borders and when treating skin tumours of central facial areas where extensive surgery can be disfiguring and where there is a high risk of recurrence after excision (14–16). Moreover in the local mana- gement of extensive metastatic cutaneous melanoma lesions, the application of repeated sessions of ECT can help to avoid the administration of invasive and/or systemic, more debilitating treatments especially in frail elderly patients with comorbidities (17) and allows, in selected cases, for combinations with immunotherapy protocols (18, 19). Our 10-year experience in the management of me- lanoma and non-melanoma skin cancer with ECT, has This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica.