This webpage contains material and links dedicated to information for students, residents, and fellows. The goal is to provide educational resources related to head and neck cutaneous malignancies. Cutaneous malignancies are the most common group of malignancies diagnosed each year. Their management requires involvement of multiple specialties and multidisciplinary collaboration for optimal oncologic and functional outcomes. In addition, cutaneous malignancies of the head and neck pose unique challenges given the functional and aesthetic issues that head and neck surgeons must consider in their management.

This webpage will be updated periodically to ensure up-to-date material relevant to management of cutaneous malignancies of the head and neck. It includes a combination of staging information, evidence-based guidelines for management, relevant publications, links to online educational resources, ongoing clinical trials, and case-based tumor board material.

Developed by the AHNS Cutaneous Cancer Section, Patient Education Subcommittee
Emre Vural, MD; Arun Sharma, MD; Jeffrey Liu, MD; Carol Lewis, MD, MPH; Mark Jameson, MD, PhD

General Resources for Education Materials Related to Cutaneous Cancers

The AHNS has developed a comprehensive curriculum for fellows receiving advanced training in head and neck surgical oncology.  A link to the curriculum is listed below.  Material specific to cutaneous malignancies can be found on page 3 of the curriculum.  The curriculum serves as a comprehensive study guide, and includes an excellent reading list.

• AHNS Fellowship Curriculum

The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) has also created several available sources of education materials, including COCLIA and OTOSOURCE.  Links to materials relevant to head and neck cutaneous cancers are listed below:

• AAOHNSF OTOSOURCE: Non-melanoma skin cancer
• AAOHNSF OTOSOURCE: Cutaneous melanoma
• AAOHNSF COCLIA: Cutaneous melanoma
• AAOHNSF COCLIA: Cutaneous malignancy

In recent years, the AHNS has also sponsored a series of review articles (Do you know your guidelines?), published in the journal Head and Neck. Articles listed below are relevant to cutaneous cancers.

• Do you know your guidelines? Diagnosis and management of cutaneous squamous cell carcinoma.
• Do you know your guidelines? Diagnosis and management of cutaneous head and neck melanoma.
• Merkel cell carcinoma: Do you know your guidelines?

Staging and Diagnosis of Cutaneous Cancers

Proper diagnosis, staging, and treatment of head and neck cutaneous malignancies are important in order to optimize outcomes for patients. Several resources are available to serve as guides to the approach toward proper management of these cancers.  Valuable resources include the published guidelines produced by the National Comprehensive Cancer Network (NCCN^®), a non-profit alliance of cancer centers.

NCCN Guidelines and Staging for cutaneous malignancies: The following links of NCCN^® guidelines for individual cutaneous malignancies necessitate one-time, free of charge registration to the NCCN^® website by the user.

• Basal Cell Carcinoma
• Cutaneous Squamous Cell Carcinoma
• Cutaneous Melanoma
• Merkel Cell Carcinoma
  

Additional Reading

The resources above provide several references for highly relevant reading material within the various links.  In addition, the AHNS sponsors a monthly journal club, with a recent series devoted to cutaneous malignancies in May 2020: AHNS Journal Club – Cutaneou Cancer Section Edition

The Cutaneous Cancer education subcommittee also provides the following list of landmark articles.  This list is not comprehensive, but a resource to highlight select studies that have had a critical impact upon the current management of cutaneous malignancies:

The Multicenter Selective Lymphadenectomy Trial (MSLT) I and II trials provide evidence-based data for the role of sentinel lymph node biopsy for intermediate-thickness cutaneous malignant melanoma.

• Multicenter Selective Lymphadenectomy Trial (MSLT) – I
• Multicenter Selective Lymphadenectomy Trial (MSLT) – II

The following published trial provided support for the FDA-approval for vismodegib for recurrent/metastatic basal cell carcinoma:

• Sekulic A, et al, Efficacy and safety of vismodegib in advanced basal-cell carcinoma. New England Journal of medicine. June 7, 2012.

The following published trials provided the support for the FDA-approval for the PD-1 inhibitors cemiplimab and pembrolizumab indicated for unresectable/metastatic cutaneous squamous cell carcinoma.

• Migden MR et al, PD-1 Blockade with Cemiplimab in Advanced Cutaneous Squamous-Cell Carcinoma. New England Journal of Medicine, July 26, 2018.
• Grob JJ et al, Pembrolizumab Monotherapy for Recurrent or Metastatic Cutaneous Squamous Cell Carcinoma: A Single-Arm Phase II Trial (KEYNOTE-629). Journal of Clinical Oncology. September 1, 2020.

Clinical trials

There are several active clinical trials targeting cutaneous malignancies.  Registered trials can be found at:

• ClinicalTrials.gov

Relevant trials can be identified using search terms related to the malignancies and/or agents of interest.

Additional Resources

Additional educational resources are continually being produced by the AHNS.  Below, please find some other links that may be instructive.

• Fellow’s Virtual Tumor Boards, provided by AHNS Curriculum Development and Maintenance Service. This is a live monthly simulated tumor board directed by AHNS faculty and sponsored for the education of active AHNS fellows.  The link provides recordings of past tumor boards and information for upcoming sessions.

Links to upcoming meetings

• Meetings of the American Head *& Neck Society (AHNS)
• Meetings of the International Federation of Head & Neck Oncologic Societies (IFHNOS)
• Multidisciplinary Head and Neck Cancers Symposium
• Combined Otolaryngology Spring Meeting (COSM)
• American Academy of Otolaryngology Head & Neck Surgery (AAOHNS)