Skin Cancer of the Head and Neck

Overview of Head and Neck Skin Cancers

Skin cancers of the head and neck are among the most common forms of cancer, mainly because these areas have frequent exposure to sunlight, a significant risk factor for skin cancer. Understanding the types, risks, and treatment options can be vital to managing and preventing these cancers. Types of Skin Cancer

There are three common skin cancer types, each named after the skin cells from which they originate:

• Basal Cell Carcinoma (BCC): The most common type. BCCs usually develop on sun-exposed areas, like the face and neck. They tend to grow slowly and are the least likely to spread, but they still need treatment to prevent them from growing large and causing more serious problems.
• Squamous Cell Carcinoma (SCC): The second most common type. SCCs also appear on parts of the skin that have been in the sun often. They can grow faster than BCCs and have a higher risk of spreading, especially if left untreated.
• Melanoma: Less common than BCC and SCC but more dangerous. Melanoma can develop anywhere; it is not limited to areas exposed to the sun. It’s more likely to grow and spread rapidly, which makes early detection and treatment crucial.

There are also other, more rare forms of skin cancer that affect the head and neck:

• Adnexal Carcinomas
• Kaposi’s Sarcoma
• Merkel Cell Carcinoma
• Sebaceous Gland Carcinoma
• T-cell Lymphomas of the Skin

Changes in your head and neck skin are the most obvious signs of skin cancers of the head and neck, such as new growths, sores that don’t heal, or changes in existing moles (size, shape, color). BCCs often look like flesh-colored round growths, pearly bumps, or pinkish patches of skin. SCCs might appear as rough or scaly red patches, open sores, or raised growths with a central depression; they may crust or bleed. Melanomas are often noticeable through a change in a mole or the appearance of a new, darkly colored, or unusual-looking growth on the skin.

Several factors can put you at greater risk for head and neck skin cancers, including:

• Sun Exposure: UV radiation from the sun or tanning beds is a significant risk factor
• Skin Type: People with light skin, hair, and eyes are at higher risk
• Genetics: A history of skin cancer in your family members can mean you are at higher risk
• Age: Older individuals have a higher risk due to prolonged UV exposure over time
• Previous Skin Cancer: Having had skin cancer once increases the risk of developing it again

Sunscreen use, protective clothing, and tanning bed avoidance are vital steps that can help reduce your risk of developing head and neck skin cancers. Likewise, self-exams and professional exams by a dermatologist can help catch skin cancer early.

Treatment depends on the type, size, location, and cancer stage. It might include surgical removal of the cancerous tissue, radiation therapy or topical treatments for less invasive cancers, and targeted therapy or immunotherapy for more advanced melanomas. Head and neck skin cancers can often be treated successfully, especially when caught early. Prevention, vigilant monitoring for changes in the skin, and prompt treatment are crucial to managing these cancers effectively. If you notice any changes in your skin, it’s essential to see a healthcare provider or a dermatologist for evaluation.

Squamous Cell Carcinoma (SCC)

• Appearance: It might look like a rough or scaly red patch, which can bleed or crust over. It might also appear as a raised growth or lump, sometimes with a lower area in the center.
• Texture: The lesion can feel crusty or rough and may be tender or painful when touched.
• Location: It also appears in sun-exposed areas but can occur anywhere on your skin, and even inside the mouth or on the genitalia.

Melanoma

• Changes in Moles: Watch for changes in existing moles, such as growth, change in color or shape, irregular edges, or moles that look different from others.
• New Growths: The appearance of new, unusual growths or spots on the skin that are dark, multicolored, or irregular in shape.
• Symptoms: Melanomas can itch, bleed, or feel painful, though they may also be symptomless.

General Warning Signs (ABCDEs of Melanoma)

• Asymmetry: One half of the mole doesn’t match the other.
• Border: Edges are irregular, ragged, or blurred.
• Color: The color may include shades of brown or black, or even areas of pink, red, white, or blue.
• Diameter: The spot is larger than a pea (larger than 6mm).
• Evolving: The size, shape, or color of the mole changes over time.

Early detection of skin cancer significantly increases the effectiveness of treatment. Regular self-examinations and professional skin checks can help identify suspicious changes early. If you notice any of these symptoms or other unusual changes in your skin, it’s essential to consult a healthcare provider or a dermatologist. They can evaluate the area and, if necessary, perform a biopsy or other tests to determine if the changes are due to cancer. Prompt attention to changes in your skin can lead to early diagnosis and a better chance of successful treatment.

Types of Surgery for Advanced Skin Cancer

1. Mohs Micrographic Surgery: For certain types of skin cancer and locations where preserving as much healthy tissue as possible is essential (like on the face), Mohs surgery might be an option. It’s a precise technique where the surgeon removes cancer layer by layer, examining each layer under a microscope during the surgery until no cancer cells remain. This method helps spare more healthy tissue while ensuring cancer removal.  This is generally done for early or smaller skin cancers and done by a specially trained dermatologist. 
2. Wide Local Excision: This procedure involves removing the tumor and a margin of healthy tissue around it to ensure all cancerous cells are removed. The size of the margin depends on the cancer’s size and location. The goal is to get clear margins, which means no cancer cells are found at the edges of the removed tissue.
3. Lymph Node Dissection: If there’s a risk that cancer has spread to the lymph nodes, a lymph node dissection or sentinel lymph node biopsy might be performed. This involves excising at least one lymph node to check for cancer cells.
4. Reconstructive Surgery: For advanced cancers, especially those that require the removal of large areas of tissue or affect critical structures (like the nose, ears, or lips), reconstructive surgery may be necessary. This can help restore the appearance and function affected by the removal of cancerous tissue. 

Before surgery, you’ll consult your surgical team to discuss the procedure, potential risks, and the recovery process. Pre-operative imaging tests may be conducted to plan the surgery.

Surgery is performed under anesthesia so that you won’t feel pain during the procedure. The length and complexity of the surgery depend on the cancer’s location and extent.

Recovery after surgery varies based on the surgery’s extent and your overall health. Hospital stay, pain management, wound care, and follow-up appointments will be part of your post-operative care. Your team will also discuss rehabilitation if necessary, especially if the surgery involves significant reconstruction.

For advanced head and neck skin cancer, a team of specialists may be involved in your care, including dermatologists, head and neck surgical oncologists, plastic surgeons, radiation oncologists, and others. This multidisciplinary approach ensures that all aspects of treatment, from cancer removal to recovery and rehabilitation, are addressed.

The goal of surgery for head and neck skin cancers is to remove all cancerous cells while minimizing the impact on your appearance and function. Advances in surgical techniques and reconstructive surgery have significantly improved outcomes, allowing many patients to maintain quality of life after treatment.

After surgery, regular follow-up is vital to check for any signs of  recurrence and to manage side effects or complications from treatment. Your healthcare team will guide you through this process, offering support and additional treatments if necessary.

Radiation Therapy

Radiation therapy uses high-energy beams, such as X-rays or protons, to kill cancer cells. It can be used after surgery to eliminate any remaining cancer cells or as the primary treatment for cancers that can’t be entirely removed by surgery.

Topical Treatments

Topical treatments (medicines applied to the skin) can be an option for early-stage or superficial skin cancers. In this approach, you apply creams or gels containing anti-cancer agents directly to your skin. These treatments are generally used for less aggressive types of cancer, like some superficial BCCs or actinic keratosis, a precancerous skin condition.

Cryotherapy

Cryotherapy is the process of freezing cancerous cells using liquid nitrogen. The frozen cells die and then slough off. This method might be an option for treating precancerous skin conditions or tiny, early-stage skin cancers.

Photodynamic Therapy (PDT)

PDT uses a combination of laser light and drugs induce photosentivity (sensitivity to light) in cancer cells. It can destroy cancer cells with minimal damage to surrounding healthy tissue and is typically considered for treating early-stage or superficial skin cancers.

Targeted Therapy and Immunotherapy

For more advanced skin cancers, such as melanoma or skin cancers that have spread, doctors may use targeted therapy or immunotherapy. These treatments focus on specific genetic mutations within cancer cells or boost the body’s immune system to fight cancer, respectively.

Chemotherapy

Though less common for skin cancer, chemotherapy can be used when the cancer is advanced or has spread to other parts of the body. Depending on the situation, it may be administered topically, orally, or through IV.

Emphasis on Early Detection

Early skin cancer detection through regular self-examinations and dermatologist visits can lead to a broader range of treatment options and generally better outcomes. If you notice any changes in your skin, it’s essential to seek medical advice promptly.