SURGICAL TREATMENT OF HEAD AND NECK CUTANEOUS MELANOMA: A MODERN APPROACH TO THE PROBLEM

Primary oral malignant melanoma, very rare neoplasm of melanocytic origin, usually presents as a bluish black to tan-brown colored lesion Which is accounting for 0.2 to 8% of all melanomas, 1.6% of all head and neck malignancies, and 0.5% of all oral neoplasia. In general, the prognosis of oral melanoma is poor and worse than that of cutaneous melanoma. Here a case of oral malignant melanoma is presented, which was undetected during the first visit to a dental clinic. When a simple oral surgical treatment was carried out in that region, it resulted in the appearance of a massive pigmented lesion which was histopathologically diagnosed as malignant melanoma. This paper is presented to reemphasize the fact that any pigmented lesion in the oral cavity should be viewed with suspicion and proper investigation (biopsy) should be carried out to rule out any untoward experiences later.

Download Full-text

Positive Margins in Cutaneous Melanoma of the Head and Neck: Implications for Timing of Reconstruction

Otolaryngology ◽

10.1177/0194599820969178 ◽

2020 ◽

pp. 019459982096917

Author(s):

Arya W. Namin ◽

Lauren Welby ◽

Austin T. Baker ◽

Laura M. Dooley

Keyword(s):

Surgical Treatment ◽

Head And Neck ◽

Cutaneous Melanoma ◽

Spindle Cell ◽

National Cancer Database ◽

Clinicopathologic Features ◽

Lentigo Maligna ◽

Positive Margins ◽

Lentigo Maligna Melanoma ◽

The Face

Objective The aim of this study is to identify clinicopathologic features associated with positive margins after surgical treatment of cutaneous melanoma of the head and neck (CMHN). Study Design Retrospective cohort study. Setting National Cancer Database. Methods A retrospective analysis of the National Cancer Database was performed of patients diagnosed with CMHN between 2004 and 2016. Univariate and multivariate analyses examining the association of clinicopathologic features with positive margins were performed via logistic regression analysis. Results A total of 101,560 patients met inclusion criteria. The incidence of positive margins was 5.0% (5128/101,560). Patients were significantly more likely to have positive margins with the following: increasing age ( P < .001; odds ratio [OR], 1.028; 95% CI, 1.026-1.031), the lip subsite ( P < .001; OR, 1.664; 95% CI, 1.286-2.154), the eyelid subsite ( P < .001; OR, 2.380; 95% CI, 1.996-2.838), the face subsite ( P < .001; OR, 1.215; 95% CI, 1.133-1.302), the lentigo maligna/lentigo maligna melanoma subtype ( P = .019; OR, 1.099; 95% CI, 1.016-1.188), the desmoplastic subtype ( P < .001; OR, 1.455; 95% CI, 1.261-1.680), the spindle cell subtype ( P = .006; OR, 1.276; 95% CI, 1.073-1.516), and advanced pT classification. Patients with male sex ( P < .001; OR, 0.733; 95% CI, 0.687-0.782) and without ulceration ( P < .001; OR, 0.803; 95% CI, 0.736-0.876) were significantly less likely to have positive margins. Conclusion The following have been identified as clinicopathologic features associated with positive margins after surgical treatment of CMHN: increasing age, female sex, the lip subsite, the eyelid subsite, the face subsite, ulceration, the lentigo maligna/lentigo maligna melanoma subtype, the desmoplastic subtype, the spindle cell subtype, and increasing pT classification.

Download Full-text

Does morphology have real impact on local and distant recurrences in head and neck cutaneous melanoma?

Head and neck tumors (HNT) ◽

10.17650/2222-1468-2020-10-3-55-64 ◽

2020 ◽

Vol 10 (3) ◽

pp. 55-64

Author(s):

A. M. Mudunov ◽

M. B. Pak ◽

L. V. Demidov ◽

K. A. Baryshnikov

Keyword(s):

Prognostic Factors ◽

Surgical Treatment ◽

Local Recurrence ◽

Head And Neck ◽

Cutaneous Melanoma ◽

Primary Tumor ◽

Resection Margin ◽

Tumor Thickness ◽

Treatment Results ◽

Level Of Invasion

Introduction. The term “local recurrence” is usually understood as regrowth of a tumor after surgical treatment. The regrowth appears within 3–5 cm from postoperative cicatrix. The causes for such prolonged tumor growth or recurrence of patients with cutaneous melanoma are nonradical surgical treatment as well as satellite or transit metastases that were not removed in-block with primary tumor. A great number of clinical researches, aimed at examination of melanoma, its patterns, anatomical criteria and features of clinical course, gave an opportunity to separate satellite or transit metastases into an independent group. Such metastases are realized inside or subdermally, up to 2 cm or more than 2 cm from the primary tumor, yet, not reaching the location of the first regional barrier.The aim of the study is to define influence of the main prognostic factors such as tumor thickness according to Breslow, the level of invasion according to Clark and the presence of ulceration on the frequency of local recurrence with cutaneous melanoma of head and neck.Materials and methods. The research involved 174 patients with cutaneous melanoma of head and neck (1995–2014). According to our index of contraction of a skin flap (median 30 %) the true borders of resection were clearly defined within all the patients. Thereby, 3 groups were identified with the following resection margin: 1.0 cm, where followed-up treatment results were analyzed.Results. Progression-free survival didn’t correlate with the size of surgical resection margins. The survival rates were the best with the lowest resection margin under 0.5 cm (77.3 %) and the worst with the highest resection margin more then 1.0 cm (38.7 %). That means that the treatment results don’t depend on the width increase of tumor resection margin.Conclusions. We consider that clear surgical margins for any thickness of cutaneous melanoma of head and neck should be as follows: 4 mm – 0.72 mm (p = 0.016). In our work, the influence of the main prognostic factors, such as tumor thickness according to Breslow, level of invasion according to Clark and ulceration on the frequency of head and neck cutaneous melanoma local recurrences had no impact.

Download Full-text

Eating Green: Shining Light on the Use of Dietary Phytochemicals as a Modern Approach in the Prevention and Treatment of Head and Neck Cancers

Current Topics in Medicinal Chemistry ◽

10.2174/1568026618666180112160713 ◽

2018 ◽

Vol 18 (3) ◽

pp. 182-191 ◽

Cited By ~ 10

Author(s):

Linda L. Eastham ◽

Candace M. Howard ◽

Premalatha Balachandran ◽

David S. Pasco ◽

Pier Paolo Claudio

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Head And Neck ◽

Cancer Cell ◽

Squamous Cell ◽

Treatment Strategies ◽

Lifestyle Changes ◽

Neck Squamous Cell Carcinoma ◽

Laboratory Research ◽

Modern Approach

Enthusiasm for the use of dietary bioactive compounds as chemopreventive agents and adjuvants for current therapies has increased laboratory research conducted on several types of cancers including Head and Neck Squamous Cell Carcinoma (HNSCC). The green chemoprevention movement is a modern approach to highlight healthy lifestyle changes that aim to decrease the incidence of HNSCC. A healthy diet can be an effective way to prevent the development of oral cancers. Discovery of the naturally occurring plant based compounds called phytochemicals has facilitated the development of new treatment strategies for patients that are at risk for, or have developed HNSCC. Many of these compounds have been shown to elicit very potent anti-carcinogenic properties. While there are many compounds that have been studied, the compounds from two specific categories of phytochemicals, phenolics (resveratrol, EGCG, curcumin, quercetin, and honokiol) and glucosinolates (sulforaphane, PEITC and BITC), are emerging as potent and effective inhibitors of oral carcinogenesis. These compounds have been shown to inhibit HNSCC growth through a variety of mechanisms. Research has demonstrated that these compounds can regulate cancer cell proliferation through the regulation of multiple cell signaling pathways. They can impede cell cycle progression, induce differentiation and apoptosis, prevent angiogenesis, and inhibit cancer cell invasive and metastatic properties. They can protect normal cells during treatment and reduce the damage caused by chemotherapy and radiotherapy. This review aims to provide an overview of some of the most effective phytochemicals that have the potential to successfully prevent and treat head and neck squamous cell carcinoma.

Download Full-text