Surgical Management of Head and Neck Melanoma

Abstract

Cutaneous malignancies are the most common group of cancers diagnosed in the head and neck. While basal and squamous cell carcinomas represent the most frequent diagnoses, cutaneous melanoma is responsible for the majority of disease-related mortality. Much of the data informing the workup and management of head and neck melanoma is extrapolated from large trials which include mostly trunk and extremity subsites. The anatomical constraints and intricacies of the head and neck region, however, require careful interpretation of the evidence to apply these treatment paradigms to care of the head and neck melanoma patient. Achieving appropriate resection margins and planning reconstructive efforts may present unique challenges. Sentinel node biopsy has proven to be safe and effective for regional nodal staging in the head and neck. Nonetheless, management of the cervical and parotid lymphatic basins requires a detailed understanding of the critical neurovascular structures involved and the potential drainage pathways. Similar to other sites, adjuvant therapy plays an important and expanding role in the management of head and neck melanoma. Clinical trials in systemic therapy, including immunomodulators and targeted inhibitors, provide future directions in the prevention and treatment of recurrent and metastatic disease. Currently, the management of head and neck melanoma requires a coordinated multidisciplinary approach and a comprehensive understanding of the available data to interpret and appropriately apply the evidence to individual patient care.