FREE SKIN (SCALP AND CHEEK)

STAGING OF NASAL VESTIBULE AND SKIN

T-stage

T1 ≤ 2 cm
T2 2-5 cm
T3 > 5 cm
T4 invades bone
skeletal muscle
cartilage

N-stage

N0 no regional LN metastasis
N1 Regional LN metastasis

PRIMARY TREATMENT

  • Free skin: surgery is typically done for small-moderate size lesions but if T4 use RT alone or a combination treatment.
  • Cheek: Extensive lesions which would require full thickness resection may be better irradiated
  • Scalp: If small then can excise but larger lesions use electrons secondary to underlying bone.

NODAL MANAGEMENT

  • Not needed for BCC

First Echelon

  • advanced (infiltrative, ulcerative)
  • recurrent

Second EcheloN Nodes

POSTOPERATIVE RADIATION

RADIATION TREATMENT

LOCAL FIELD

  • primary tumor with 1 to 2 cm margin
  • boost with 0.5 to 1 cm margin

FIRST ECHELON NODES

  • Local Field and
  • Parotid
  • and Upper Neck Field

== SEE PAROTID FOR FIELD PICTURE ==

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