Novel use of ultrasound-guided surface marking of head and neck tumors invading facial skin

• Published in: Oral surgery, oral medicine, oral pathology, oral radiology and endodontics oral medicine, oral pathology, oral radiology and endodontics, 2006-04, Vol.101 (4), p.499-504
• Main Authors: Ng, Suk Y., Songra, Ashok K., Hutchison, Iain L.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - ultrastructure; Adult; Biological and medical sciences; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Cheek; Dentistry; Edema - diagnostic imaging; Facial Neoplasms - diagnostic imaging; Facial Neoplasms - pathology; Facial Neoplasms - surgery; Female; Forehead; Head and Neck Neoplasms - pathology; Humans; Ink; Medical sciences; Middle Aged; Mouth Mucosa - pathology; Neoplasm Invasiveness - pathology; Neoplasm Invasiveness - ultrastructure; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - ultrastructure; Neoplasms, Second Primary - diagnostic imaging; Neoplasms, Second Primary - pathology; Neoplasms, Second Primary - surgery; Otorhinolaryngology. Stomatology; Patient Care Planning; Reconstructive Surgical Procedures - methods; Skin Neoplasms - diagnostic imaging; Skin Neoplasms - pathology; Skin Neoplasms - surgery; Surgical Flaps; Ultrasonography
• ISSN: 1079-2104; 1528-395X
• DOI: 10.1016/j.tripleo.2005.05.076

Malignant tumors of deep head and neck structures can invade skin, but the tumor periphery is difficult to assess clinically. The surgeon's dilemma is achieving tumor clearance with safe margins while at the same time minimizing skin loss on the face. We show, in 2 cases involving the face, that high-resolution diagnostic ultrasound was superior to CT scan in demonstrating the periphery of the tumor. The tumor was distinguished from surrounding edema by its lower echogenicity and homogeneous echotexture. The maximum contour of the tumor was marked on the skin surface with ink under ultrasound guidance. The ink marking aided excision and reconstruction planning. Subsequent histology showed the surgical margins were clear of tumor. The patients remained tumor-free for more than 3 years. Ultrasound imaging therefore shows good potential for planning surgical resection with a safe margin and for aiding decisions on donor site and type of flap for reconstruction.