HEAD & NECK SERVICES
Fine-needle aspiration biopsy (FNA) ), is a diagnostic procedure used to investigate lumps or masses in the head and neck. In this technique, a thin needle is inserted into the mass for sampling of cells that, after being stained, will be examined under a microscope. Fine-needle aspiration biopsies are very safe, minor surgical procedures which only take a few minutes to have done in the office. Often, a major surgical (excisional or open) biopsy can be avoided by performing a needle aspiration biopsy instead. The FNA procedure is widely used in the diagnosis of cancer and other inflammatory conditions.
A needle aspiration biopsy is safer and less traumatic than an open surgical biopsy. Complications related to FNA are very rare. Common complications include bruising and soreness. There is a risk, because the biopsy is very small (only a few cells), that the problematic cells will be missed, resulting in a false negative result. There is also a risk that the cells taken will not enable a definitive diagnosis.
The doctors at Central Coast Otolaryngology are specialists in surgical treatment and management of skin cancers of the face and head and neck. Surgical excisions of facial skin cancers can in most cases be excised and reconstructed in a simple office surgical procedure.
Freezing with a liquid nitrogen spray can be used to destroy many skin growths including benign, precancerous and early skin cancers. After treatment with cryotherapy, the skin growth becomes scabbed and crusted and usually falls off within a few weeks. There may be some redness, swelling, or pigmentary changes to the skin. Cryotherapy is an excellent treatment for many benign skin lesions. It may also be a good treatment option for some pre-cancerous skin lesions or occasionally very superficial cancers, however the long-term cure rate is not nearly as good as surgical removal.
TOPICAL TREATMENTS OF PRECANCEROUS SKIN LESIONS
Chemotherapy uses drugs that kill cancer cells. Topical chemotherapy means that an anti-cancer medicine is put directly on the skin in a cream or ointment. Precancerous and early cancers in the face, scalp and neck can often be treated with topical medications: (Efudex) and Imiquimod (Aldara) are FDA-approved to treat actinic keratosis (pre-cancerous) and superficial basal cell carcinomas.
5-fluorouracil (5-FU) is a topical chemotherapy medication. When put directly on the skin, 5-FU kills tumor cells on or near the skin’s surface, but it can’t reach cancer cells deeper in the skin or those that have spread to other organs. For this reason, 5-FU is generally used only for pre-cancerous conditions such as actinic keratosis and for some very superficial skin cancers. Because the 5-FU is only applied to the skin, it doesn’t spread throughout the body, so it doesn’t cause the same side effects as systemic chemotherapy (treatment that affects the whole body). But it does make the treated skin red and very sensitive for a few weeks 5-FU can also make the skin more sensitive to sunlight, so treated areas must be protected from the sun to prevent sunburn for a few weeks after use of this cream.
Certain drugs can boost the body’s immune response against the cancer, causing it to shrink and go away. Imiquimod is a cream that can be applied to actinic keratoses and some very early basal cell cancers. Imiquimod stimulates the immune system to make interferon, a chemical which attacks cancerous and pre-cancerous cells. It causes the immune system to react to the skin lesion and destroy it. It’s typically applied at least a few times a week for several weeks, although schedules can vary. Like other topical gels, it can cause severe skin reactions in some people. It can also cause flu-like symptoms.
Diclofenac (Solaraze): A gel containing the drug diclofenac is sometimes used to treat actinic keratoses. This drug is part of a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs), which includes aspirin and ibuprofen. The gel is usually applied twice daily for 2 or 3 months. It may cause less severe skin reactions than 5-FU, but it can also take longer to work.
Ingenol mebutate (Picato): This is a newer gel used to treat actinic keratosis that might work more quickly than other topical gels. It is applied to the skin daily for 2 or 3 days. The gel can cause bothersome skin reactions, but these usually start to go away within a week of starting treatment.