Management of Confirmed SCC - requires multidisciplinary approach

1. 5 Chemotherapy - Used an adjuvant in treatment. It reduces speed of progression of the lesion and reduces risk of recurrence

2. 4. Surgery- Ensure patient is warned about side effects of surgery

2.1. Local Site - partial mandibulectomy ensuring clear margins are obtained along with reconstruction using titanium plates (primary reconstruction) and local/regional/distant flaps to reconstruct soft tissues

2.2. Regional Site- If there are no positive neck nodes an elective selective neck dissection can be done to remove nodes that might habour carcinoma. It also allows for accurate staging @ histopathology that would warrant adjuvant treatment

2.3. Distant Site - Distant flaps can be used for soft tissue reconstruction

2.4. If performing surgery the patient's health must be closely monitored. Blood glucose levels and blood pressure levels must remain under control. The decision must be made before whether the patient should be removed from Warfarin and placed on bridging anticoagulants. Obtain medical slearance

3. Review and Recall - Patient must be reviewed post treatment to address any side effects or post op complications. Monitor progression or recurrence of disease.

4. 6. Post op care - ensure patient is stable post treatment and that glucose and blood pressure levels are within normal limits.

5. 1. Determine if patient is fit enough to undergo surgery. This decision is made based on patient factors eg drug and med hx, anesthetic assessment , CBC, INR etc Decision is made using multidisciplinary approach.

6. 2. Supportive Care - This is done when lesions are inoperable or due to patient factors eg age, med hx, drug hx. Can consist or radio therapy, debulking palliative surgery. It's aim is to relieve pain and improve quality of life for the patient

7. 3. Radiotherapy - Can be used for curative and palliative treatment. SCC is moderately radiosensitive. It can be done pre surgery in the case of salvage surgery or post surgery. Warn patient about side effects.

8. Staging investigations (post biopsy)

8.1. Local - plain film radiographs, CT scans, MRI

8.2. Regional - neck ultrasound, fine needle guided ultrasound biopsy, CT Neck

8.3. Distant - Chest Xray, CT chest, abdominal ultrasound, liver function test, calcium and phosphate test

8.4. Prognosis - based on stage / extent of disease, site, grade and age of pt.

8.5. Special Investigations - CBC, White Cell Count, INR, Urea and Electrolytes

9. Treatment Plan - see boxes 1-6