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Principles of Surgery in Head and Neck Cutaneous Melanoma
Srinivasa Rama Chandra1, Sravani Singu2, Jason Foster3
1Oral and Maxillofacial Surgery, Oregon Health & Sciences University, 3181 SW Sam Jackson Park, Portland, OR 97239, USA.
Abstract:
Surgical management of head and neck melanoma starts from the primary biopsy of the cutaneous site by a narrow excision with a 1 to 3 mm margins. The margin should include the whole breadth and sufficient depth of the lesion. The key is not to transect the lesion. With the advent of molecular testing, gene expression profiling, and immunotherapies, the surgical management of advanced melanoma has changed. Sentinel lymph node biopsy is an essential armamentarium for T2a and higher staging/greater than 1 mm thick and advance stage disease. Molecular pathogenesis and cancer immunology are recognized in the recent treatment protocols along with surgery in advanced stages of melanoma.
Insights
Surgical management for head and neck melanoma involves precise biopsy and excision. Advanced melanoma treatment now integrates molecular insights and immunotherapy with surgical approaches.
Area of Science:
- Oncology
- Dermatology
- Surgical Pathology
Background:
- Head and neck melanoma management has evolved significantly.
- Traditional surgical excision remains a cornerstone of treatment.
- Advances in molecular diagnostics and immunotherapy are reshaping treatment paradigms.
Purpose of the Study:
- To outline current surgical strategies for head and neck melanoma.
- To highlight the integration of molecular profiling and immunotherapy in advanced cases.
- To emphasize the importance of sentinel lymph node biopsy.
Main Methods:
- Initial biopsy via narrow excision (1-3 mm margins), ensuring complete lesion capture without transection.
- Sentinel lymph node biopsy for T2a or higher staging/lesions >1 mm thick.
- Incorporation of molecular pathogenesis and cancer immunology data into treatment protocols.
Main Results:
- Surgical management emphasizes precise initial biopsy and adequate margins.
- Sentinel lymph node biopsy is crucial for staging and treatment decisions in advanced melanoma.
- Multimodal treatment strategies combining surgery, molecular analysis, and immunotherapy are increasingly utilized.
Conclusions:
- Current surgical management of head and neck melanoma requires meticulous technique.
- Advanced melanoma treatment necessitates a comprehensive approach integrating surgery with molecular and immunological strategies.
- Sentinel lymph node biopsy is a critical component for accurate staging and patient management.
