Introduction
Squamous cell carcinoma (SCC) of the nasal vestibule is a rare
malignancy (1,2). Risk factors for nasal carcinomas include male gender,
smoking and exposure to organic solvents (3). Human Papilloma Virus
infection has been identified in a significant proportion of tumours,
although its prognostic impact remains unclear (4,5). Nasal vestibule
malignancies can present with non-specific symptoms, sometimes
masquerading as a dermatosis (6) and leading to a delay in diagnosis.
Due to the heterogeneity of published series, the level of evidence
regarding the management of nasal SCC remains low. There is a lack of
consensus for the treatment of both the primary tumour and the
clinically N0 neck. While most authors recommend upfront surgery
(rhinectomy) even for early stage tumours (2,7–9), interstitial
brachytherapy and radiotherapy seem to be acceptable non-surgical
alternatives (2,10,11). However, for locally advanced tumours, surgery
in the form of Total Rhinectomy (TR) remains the mainstay of treatment
(12,13). For the nodal management of cN0 vestibule SCCs, authors have
recommended several strategies including surveillance, elective neck
dissection and prophylactic radiotherapy (7,13).
The staging of nasal tumours is also controversial with three main
tumour classifications being used i.e. Wang’s classification,
8th edition of AJCC staging system for tumours of the
nasal cavity and ethmoid sinus, and the AJCC staging system for
nonmelanoma skin cancer of head and neck region (see table 1) (14,15).
Wang’s classification is specifically designed for vestibule tumours,
and therefore may better represent the natural evolution of tumours at
this anatomical subsite (15,16). Indeed, the local extension pathways
and the specific lymphatic drainage of nasal cavity malignancies justify
using a specific classification system to infer disease management
(17,18).
The need for clear excisional margins alongside the anatomical and
cosmetic constraints make indications for partial rhinectomies rare.
Furthermore, they require a challenging surgical reconstruction (16)
whereas prosthetic reconstruction after TR brings satisfactory cosmetic
outcomes (19). However, the psychological impact of TR can be
significant and therefore must not be underestimated (19).
The aim of this retrospective single centre study was to analyse the
outcomes of TR for the treatment of nasal vestibule SCCs and to identify
risk factors for disease recurrence.