THE SKIN TUMORS EVOLVED FROM THE FACE. EXPERIENCE OF THE PLASTIC SURGERY DEPARTMENT CHU MOHAMMED VI ABOUT 60 CASES

The malignant skin tumors advanced of the face represent a serious pathology due to its location, its evolutionary potential and especially its vital prognosis. All these factors and others justify the collective care as early as possible while respecting the convenience of the patient. From a retrospective study spread over a period of 7 years and half, we analyzed the epidemiological and clinical characteristics, the delay of diagnosis, the type of therapy and the outcome of 60 patients in our structure. The age of our patients varies between 7 and 89 years with an average age of 63 years and a clear male predominance (sex ratio = 3). The rural origin accounted for 87% and the majority of professions exposed to the sun. The mid-facial region was the site of 60% of the tumors studied. Histological results showed basal cell carcinoma predominance of 55%, followed by squamous cell carcinoma 40% and melanoma 2%. Tumors were classified as T4 in 73% with a concentration lesions mid-lock face/mid-facial 60%. The tumor resection was the rule in all our patients while respecting a margin of safety adapted to the histological type and tumor size. These margins were complete in 48 patients, incomplete in 12 patients (Xp and Epidermodysplasia) whose goal of resection was initially palliative. Lymph node dissection was performed in 7 patients. Exenteration was performed in 10 patients. A parotidectomy was performed in 5 patients. The repair process was adapted to the seat and the extent of the defects. Reconstruction was deferred in 83% of cases and involved various ways of skin grafting to muscular cutaneous flaps. Adjuvant radiotherapy was indicated in 17 patients. These findings should lead us for more precaution and to rethink our carcinological and reconstructive approach. The deployment of simple means allows local monitoring and prioritizes other means according to needs. A preventive approach remains a pillar in the management of these "historical" tumors.