A 65-year-old male presented with a painful ulcerative lesion on the left side of his face that had been gradually increasing in size over the past year. Examination revealed an ulcerated tumor measuring 5cm by 3cm involving the upper lip, right angle of the mouth, and lower half of the nose. The lesion was excised and found to be squamous cell carcinoma on histopathological examination. Treatment for the patient would depend on accurate staging of the cancer including its size, involvement of lymph nodes or distant organs, the patient's overall health, and whether combination therapies like surgery and radiation are appropriate. The goal of treatment is complete removal of the cancer while preserving function and minimizing long-term side effects.

3. Malignant neoplasms
arising from mucosal
surface epithelium
exhibiting squamous
differentiation as
characterized by the
formation of keratin

4. A 65 year old male reported to Ear, Nose and Throat (ENT)
outpatient with painful ulcerative lesion of left lower two
third of the face. It started as a tiny lesion at left
nasomaxillary groove one year back. This gradually
increase in size.On clinical examination,it was an ulcerated
lesion of 5cm by 3 cm involving whole upper lip and right
angle of mouth.The lesion extended to involve lower half of
collumella and adjacent zygomaxillary lesion.The margins
were irregular and the base was covered with purulent
secretion.After cleaning, debridement the whole lesion was
excised.On histopathological examination it was diagnosed
as SQUAMOUS CELL CARCINOMA.
( Journal of Pakistan Medical Association)

5. HOW WOULD YOU
MANAGE THIS
PATIENT??????????

6. • EARLY DIAGNOSIS
• TUMOUR SIZE
• USUALLY ONLY ONE CHANCE TO CURE
• RECURRENCE
• COMPLEX
• DEPENDS ON AGE, MEDICAL CONDITION,EXACT
SIZE,DEGREE OF SPREAD AND HISTOLOGICAL
TYPE.
• CO-ORDINATED BY MULTIDISCIPLINARY TEAM

7. Identify the
 Type
 Spread
 Stage of carcinoma
 Evaluate co morbidity

8. • Clinical examination and imaging
CLINICAL EXAMINATION:
 Palpation
 Clinical signs, such as nerve palsies, also indicate
extent of spread.
IMAGING:
CT Scan
MRI
PET
(includes neck and chest to identify and exclude
lymphnode and blood borne metastasis.

9. • Biopsy of the carcinoma provide
information on the degree of
differentiation and the pattern of
spread.

10. • Patients are heavy smokers or alcoholic
• CVS , respiratory ,neurological or liver
disease poses an anesthetic risk or
compromise recovery from surgery.
• Nutritional status should be assesed.
• Patient’s psychological fitness.

12. • MULTIMODALITY THERAPY
SURGERY + RADIOTHERAPY
o SURGERY
o RADIOTHERAPY
o CHEMOTHERAPY

13. • Preferred for small carcinoma’s of
tongue
• Those involving bones b/c of the risk
of later radionecrosis and for
verrucous carcinoma.
AIM??????

14. • Neck ressection to
remove the cervical
lymph nodes along with
the juglar chain from
the base of skull to
clavicle + submental
+submandibular lymph
nodes for prevention of
relapse.

15. • Acceptable and functional result.
• Discomfort and unwanted long term effects
• External beam radiotherapy
• Telotherapy
• Brachytherapy

16. • Act by radiosensitisation as well
their direct effect on cancer cells.
• Carried out with radiotherapy for
best effect.
• Alkylating agent cisplastin + 5
fluorouracil
• Neoadjuvant therapy = b /f
surgery or radiotherapy
• Adjuvant chemotherapy after, both
reducing side effects.

17. • Advanced tumours and treatment
failure
• Radiotherapy
• Surgery when large tumours
comprises the airway or become
grossly necrotic.

18. • SENITAL NODE BIOPSY
• PHOTODYNAMIC THERAPY
• INHIBITORS OF EFGR LIKE
CETUXIMAB
• OncoVex ( engineered Herpes
Simplex Virus)
• INTENSITY MODULATED
RADIOTHERAPY