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BackTable / ENT / Podcast / Episode #135

Cutaneous Squamous Cell Carcinoma (CSCC): Evaluating Risks & Navigating Complex Surgical Reconstruction

with Dr. Gina Jefferson

In this episode of BackTable ENT, hosts Dr. Ashley Agan and Dr. Gopi Shah sit down with Dr. Gina Jefferson, professor and division chief of head and neck surgery at the University of Mississippi, to discuss the challenges of cutaneous squamous cell carcinoma (CSCC).

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Cutaneous Squamous Cell Carcinoma (CSCC): Evaluating Risks & Navigating Complex Surgical Reconstruction with Dr. Gina Jefferson on the BackTable ENT Podcast)
Ep 135 Cutaneous Squamous Cell Carcinoma (CSCC): Evaluating Risks & Navigating Complex Surgical Reconstruction with Dr. Gina Jefferson
00:00 / 01:04

BackTable, LLC (Producer). (2023, October 17). Ep. 135 – Cutaneous Squamous Cell Carcinoma (CSCC): Evaluating Risks & Navigating Complex Surgical Reconstruction [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Gina Jefferson discusses Cutaneous Squamous Cell Carcinoma (CSCC): Evaluating Risks & Navigating Complex Surgical Reconstruction on the BackTable 135 Podcast

Dr. Gina Jefferson

Dr. Gina Jefferson is a professor of otolaryngology and the chief division of head and neck oncologic and microvascular surgery at the University of Mississippi Medical Center in Jackson, Mississippi.

Dr. Ashley Agan discusses Cutaneous Squamous Cell Carcinoma (CSCC): Evaluating Risks & Navigating Complex Surgical Reconstruction on the BackTable 135 Podcast

Dr. Ashley Agan

Dr. Ashley Agan is a practicing ENT and assistant professor at UT Southwestern Medical Center in Dallas, TX.

Dr. Gopi Shah discusses Cutaneous Squamous Cell Carcinoma (CSCC): Evaluating Risks & Navigating Complex Surgical Reconstruction on the BackTable 135 Podcast

Dr. Gopi Shah

Dr. Gopi Shah is a practicing ENT at UT Southwestern Medical Center in Dallas, TX.

Synopsis

First, Gina discusses how patients are referred to her practice, as many of her patients have been diagnosed and or previously treated by another provider. Then Gina talks about risk factors for CSCC which includes UV exposure, age, fair skin, genetic disposition and immunosuppressed patients.

Next, Gina discusses the challenges of taking a biopsy for potential CSCC depending on the size and location of the lesion. Gina also discusses the use of excisional biopsies on smaller lesions whereas a punch biopsy is more helpful for a larger lesion or one that is on a difficult area such as the eyelid or nose. A punch biopsy helps in assessing depth of invasion to help in staging and diagnosis.

From a treatment perspective, Gina shares her considerations when approaching reconstruction. She is mainly concerned about how to close the defect without causing significant deformity,if the patient is going to have exposed bone, or if there is the potential for radiation. Gina also mentions that areas such as the eyelid and nose are difficult places to reconstruct due to potentially injuring nearby structures, such as the lacrimal system. In difficult cases such as these, she may count on colleagues in ophthalmology to help out in the reconstruction.

Lastly, the hosts and Gina discuss post surgical management of CSCC patients and when radiation may be considered. Gina explains what follow up for these patients may look like and the role of surveillance imaging through PET scans.

Transcript Preview

[Dr. Gina Jefferson]
Even when you are simply removing the parotid as the primary site with the overlying cutaneous squame over the parotid, you're always thinking about, can I close this locally without causing significant deformity? Particularly, you're thinking about the eye. You don't want to cause lagophthalmos. Also, you can also cause impairment of nasal breathing by distortion of the nasal vestibule with your reconstruction. Those things are first and foremost in your thought process.

Also, is this patient going to have exposed bone because when they're-- to me, they have already gotten advanced disease, so I know in my thought process they're going to undergo adjuvant radiation. If the bone is not protected well, it can lead to the terrible complication of osteoradionecrosis, which is not good for anyone. I think, in those instances, you're really considering whether or not complex tissue is more beneficial than just a simple skin graft. You're looking at the patient all over. You don't want to move a significant adjacent area that also has cutaneous disease, actinic keratosis, in situ disease. If you're just rearranging the potential of more cancer, that's also not the most helpful. You might consider full-thickness skin graft from somewhere else on the body that's not diseased. Whole host of things to consider.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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