Skin Cancer of the Head and Neck
What is skin cancer of the head and neck?
Skin malignancies are the most common cancer in the United States, responsible for more than half of all new cancer cases. These can be broken down into melanoma and non-melanoma malignancies, which are squamous cell cancer and basal cell cancer. These skin malignancies are caused by ultraviolet radiation from exposure to the sun and tanning beds.
Basal cell cancer is the most common form of skin cancer. It is rarely fatal, but it can be locally aggressive. Squamous cell cancer is the second most common skin cancer. It's more aggressive and may require extensive surgery depending on location and nerve involvement. Melanoma is the least common form of skin cancer, but it is responsible for more deaths per year than squamous cell and basal cell skin cancers combined. Melanoma is also more likely to spread and may be harder to control.
What are the symptoms of skin cancer of the head and neck?
Skin cancers usually present as an abnormal growth on the skin. The growth may have the appearance of a wart, crusty spot, ulcer, mole or sore. It may or may not bleed and can be painful. If you have a preexisting mole, any change in the characteristics of this spot - such as a raised or an irregular border, irregular shape, change in color, increase in size, itching or bleeding - are warning signs of melanoma. Sometimes the first sign of melanoma or squamous cell cancer is an enlarged lymph node.
What are the risk factors for skin cancer of the head and neck?
Tanning bed exposure
Immunosuppressive medications (like those taken by transplant patients)
Prior radiation to the head and neck area
How is skin cancer of the head and neck diagnosed?
Diagnosis is made by clinical exam and a biopsy. Basal cell and squamous cell cancers are staged by size and extent of growth. Basal cell cancers rarely metastasize to lymph nodes, but they can grow quite large and invade local structures. Squamous cell cancers have a much higher incidence of lymph node involvement in the neck and parotid gland and can spread along nerves.
Melanoma is staged based not on size but on how deep it invades the skin layers. Therefore, a superficial or shave biopsy will not provide accurate staging information used to guide treatment. Melanomas can have a very unpredictable course and can spread to distant organs. Melanomas with intermediate thickness often require sentinel node biopsy, a surgical procedure performed by a head and neck surgeon, to determine if microscopic spreading to lymph nodes has occurred.
Skin cancer of the head and neck treatment
Many early-stage small basal cell cancers or squamous cell cancers can be removed by Mohs surgery, which is a technique that spares normal tissue through repeated intraoperative margin testing, removing only the cancer and leaving adjacent normal tissue. Tumors with nerve involvement, lymph node involvement or of a large size are not suitable for Mohs surgery and require a multimodality approach to treatment with formal surgical resection and adjuvant radiation or chemotherapy.
Melanoma is more likely to spread, and aggressive surgical resection with wide margins is required in addition to radiation and/or chemotherapy.
Reviewed by Dr. Christine Gourin from the Department of Otolaryngology-Head and Neck Surgery