STATEMENTS 2008on Head and Neck Cancer

Stephane TEMAM, M.D. PhD.

Department of Head and Neck Surgery

Mucosal Melanoma

EPIDEMIOLOGY

• A rare disease <1% all melanoma• >50% of MM are in the head and

neck• Incidence remained stable• ♂ > ♀

• 7th decade

DIAGNOSIS

• Pigmented mucosal lesions

• Primary vs. metastasis– Pathological characteristics (IHC)– Precursor lesions

STAGING and WORKUP

• AJCC 2002 TNM classification is not accurate because almost all patients are T4b (>4 mm in thickness)

• A total body skin examination• CT-Scan / MRI of the head and neck

• DM– CT-Scan / PET: brain, chest, abdomen,

pelvis– Serum lactate dehydrogenase

Sites

• Nose and paranasal sinuses• Oral cavity

– Hard palate and maxillary alveolus

• Other sites : rare

Surgery

• Radical and wide surgical resection

• Controversies– How large (2cm margins) : anatomical and

functional limitations as SCC– Extensive In Situ melanosis– Systematic treatment of the neck or SNB for

staging for oral melanoma– Therapeutic neck dissection is questionable

Survival

• Recent reports:– Local control rate : 29% to 52%– 5-year overall survival rate : 20% to

35%– Long term survival patients– DM 47% to 62%

• associated with Local relapse• Positive neck nodes #100%

Radiotherapy

• In vitro: a high capacity for repair of sublethal DNA-damage radioresistance

• Hypofractionation (dose/fraction>4Gy) recommended on a large non-randomized study, but not confirmed on a small size PIII RTOG trial for cutaneous M

• Limitation : proximity to the optical structures and the central nervous system.

Radiotherapy

• Improve local control after surgery

• Indicated for unresecable disease

• Unresolved questions– Elective nodal irradiation– Total dose and Fractionation– New modalities : volume, neutron,

proton– Use of chemotherapy and possibly

new target therapy in concomittent or adjuvant setting

Systemic treatment

• Palliative setting

• But also as adjuvant treatment for advanced stages– Cutaneous melanoma protocols– But different biology: cGH-arrays distinct

sets of genetic alterations