The Invasiveness Of Skin Or Soft Tissue Tumors And Selection Of Surgical Treatment

Purpose:In the process of treating malignant skin tumors, plastic surgeons often face the dilemma about how large the scope of extended resection should be and the selection of methods for wound reconstruction, however, tumor invasiveness is one of the important factors to be considered. Invasiveness is a major characteristic of malignancy which directly related with tumor cell residues and short-term tumor recurrence after surgery. Our study discusses the invasiveness of Basal Cell Carcinoma and Squamous Cell Carcinoma through the assessment of the expression of E-cadherin,β-catenin, and HER-2 in the tumor tissues, and we take normal skin and seborrheic keratosis tissues as comparison. Through the invasiveness assessment along with the analysis of the postoperative prognosis of clinical cases in this paper, we are looking forward to find a way to help decide the scope of extended resection and choose the proper method of wound reparation after tumor removal through the tumor invasiveness assessment. Method:Select pathological specimens include normal skin, seborrheic keratosis, basal cell carcinoma and squamous cell carcinoma. After paraffin-embedded serial sections of all the specimens, immunofluorescence staining of E-cadherin,β-catenin, and HER-2 is carried out to observe the staining results in order to evaluate tumor invasiveness of different pathological types. Clinical cases with different types of malignant skin tumors from trunk after surgical removal were selected and skin defects were following repaired with bilobed flap. In the manner described, skin defect was repaired using bilobed flap following extended tumors resection from 12 patients. The largest area of skin defect among all cases measured is 25 cm by 22 cm.Results:The expression of E-cadherin andβ-catenin is higher in epidermal cells in the normal skin and seborrheic keratosis but decreased in that of basal cell carcinoma and squamous cell carcinoma. HER-2 expression in basal cell carcinoma and squamous cell carcinoma is higher than that in normal skin and increased skin SK. After reconstruction of skin defects with bilobed flap after extended resection of malignant skin tumors located in the chest, abdomen, and perineum, the blood supply of skin flaps was all good with eleven patients healed successfully and the appearance turned out to be satisfying. One patient initially suffered from partial flap necrosis, but recovered after continuing dressing change. All the patients had been followed up for an average period of one years, and the tumors had showed no signs of recurrence and metastasis.Conclusion:The debate is still out about how to repair defects after extended resection of malignant skin or soft tissue tumors, E-cadherin,β-catenin, and HER-2 expression in skin tumors is an important indicator in the assessment of tumor invasiveness which plays a role in guiding clinical surgical treatment. For malignant skin tumors with average invasiveness, first-stage reconstruction using bilobed flap after the surgical removal of malignant skin tumors from the trunk had been proved simple, efficient, safe, reliable, with limited scarring and easily accepted by patients. On the premise of complete tumors resection, no evidence indicates that the application of this method in repairing the skin and soft tissue defect will bring about recurrence and metastasis of the tumor. Through our study, we hope that we can offer grading for invasiveness of skin tumors according to preoperative tumors biopsy and E-cadherin,β-catenin, and HER-2 expression analysis. On the basis of the grading, we can choose proper surgical treatment for different types of tumor and carry out long-term follow-up programs in order to improve prognosis and quality of life for patients.