Head and neck melanoma (excluding ocular melanoma): United Kingdom National Multidisciplinary Guidelines

Abstract

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the United Kingdom. This paper provides consensus recommendations on the management of melanomas arising in the skin and mucosa of the head and neck region on the basis of current evidence.Recommendations• At-risk individuals should be warned about the correlation between ultraviolet radiation (UVR) exposure and skin cancer, and should be given advice on UVR protection. (R)• Dermatoscopy can aid in the diagnosis of cutaneous melanoma. (R)• Histological examination after biopsy is essential to confirm the diagnosis and the tumour thickness. (G)• Excisional biopsy is method of choice. (G)• Staging investigations can be performed for both regional and distant disease. (R)• Scanning (computed tomography (CT) and/or magnetic resonance imaging) is recommended for patients with high-risk melanoma. (G)• Patients with signs or symptoms of disease relapse should be investigated by imaging. (R)• Imaging of the brain should be performed in patients who have stage IV disease. (G)• Patients with melanoma of unknown primary should be thoroughly examined and investigated for a potential primary source. (R)• Primary cutaneous invasive melanoma should be excised with a surgical margin of at least 1 cm. (G)• The maximum recommended excision margin is 3 cm. (R)• The actual margin of excision depends upon the depth of the melanoma and its anatomical site. (G)• Ultrasound-guided fine needle aspiration (FNA) or core biopsy of suspected lymphadenopathy is more accurate than ‘blind’ biopsy. (R)• Open biopsy should only be performed if FNA or core biopsy is inadequate or equivocal. (R)• Prior to lymph node dissection, staging by CT scan should be carried out. (R)• If parotid disease is present without neck involvement, both parotidectomy and neck dissection should ideally be performed. (R)• There is no role for elective lymph node dissection. (R)• Sentinel lymph node biopsy (SLNB) can be considered in stage IB and above by specialist skin cancer multidisciplinary teams. (G)• Patients should be made aware that SLNB is a staging procedure, and should understand that it has, as yet, no proven therapeutic value. (R)• All patients with cutaneous melanoma should have their original tumour checked for BRAF gene status, and their subsequent targeted biological therapy based on this. (R)• Patients who develop brain metastases should be considered for stereotactic radio-surgery. (R)

Identification and Functional Evaluation of miR-4633-5p as a Biomarker and Tumor Suppressor in Metastatic Melanoma

“…Patients were followed up in October, 2016. For the convenience of statistical analysis, all tumors were staged according to the 7 th edition of AJCC Cancer Staging Manual, which was replaced by a TNM staging system in the 8 th edition [14]. Mutational status of the clinical specimens was not available.…”

“…In melanoma, Akt was reported to promote tumor growth, metastasis and development of chemoresistance [13]. Furthermore, the phosphorylation status of Akt was also associated with activity of MMP2 (matrix metalloproteinase-2) in melanoma, which cooperatively expedites the invasion of melanoma cells and, thus, metastasis [14].…”

Geographic region: Does it matter in cutaneous melanoma of the head and neck?

“…Melanoma accounts for 65% to 75% of deaths related to skin cancer, with cutaneous head and neck melanoma (CHNM) comprising 12% to 21% of all cases per year . Incidence of melanoma has been increasing dramatically in recent years, but prognosis has improved, with lesions being identified more often at earlier stages . Relative tumor density (RTD) represents a ratio of melanoma concentration relative to skin surface area .…”

“…Relative tumor density (RTD) represents a ratio of melanoma concentration relative to skin surface area . Although the head and neck area is not the most common site for melanoma occurrence overall, when compared to other anatomic sites, this region has the highest RTD, indicating a tumor preference for this location . The most common site of CHNM varies depending on age and gender, but it often manifests on the scalps and ears of older males and the faces of younger females .…”

“…Melanoma, including CHNM, mostly affects fair‐skinned Caucasian individuals . Ultraviolet radiation (UV) exposure remains the primary environmental risk factor consistently implicated in melanoma development . Incidence classically follows the latitude gradient, which describes a pattern of distribution in which melanoma rates are higher at latitudes closer to the equator than further away .…”