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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SHOW NOTES

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.