Skin - cutaneous malignancies

Although the skin of the head and neck accounts for less than 10% of the body's surface area, 70% to 80% of cutaneous malignancies occur in this region. As a result of greater sun exposure during occupational and recreational activities and the depleted ozone layer (with increased ultraviolet-B exposure), the incidence of skin cancer is increasing and the initial age at presentation is decreasing .

About 3,000 yearly deaths are attributable to nonmelanoma cutaneous malignancies; morbidity occurs in a manyfold greater number of people, however, in terms of medical costs, cosmetic deformity, and loss of function. About 1,000,000 new nonmelanoma skin cancers are projected annually in the United States. Treatment is protracted because of the recurrent nature of the disease, the need for repeated reconstructive efforts, and the propensity of second primary skin cancers to occur.

Most early lesions are successfully controlled on the first attempt with conservative local therapy. But advanced skin cancer of the head and neck is not controlled easily, and its frequently devastating physical consequences can have tremendous influence on a patient's psychological well-being.

In a phase II study of systemic therapy in advanced SCC of the skin, isotretinoin plus IFN-α had major activity primarily limited to advanced local and regional disease. The second phase II study of systemic therapy plus IFN in SCC produced substantial activity in extensively advanced disease (eg, stage T3 and T4). Smaller series of cytotoxic chemotherapy combinations in similar patient populations reported overall response rates in the 60% to 70% range. (Melanoma of the head and neck region is considered in a separate section.)

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