Keeping Watch for Skin Cancers on the Head and Neck

“At M.D. Anderson, we have a clinical trial underway to assess the effectiveness of using gefitinib [Iressa] for treating locally aggressive and metastatic SCC,” said Dr. Weber. Gefitinib is a chemotherapy drug currently approved for patients with non-small-cell lung cancer.

“In Australia, where two out of every three people will be affected by skin cancer over their lifetime, we are conducting a prospective randomized clinical trial to see if postoperative concurrent chemoradiotherapy results in improved cure rates compared with postoperative radiotherapy alone in SCC,” said Dr. O’Brien.

Vaccine Trials

Large phase III clinical trials using peptides, gangliosides, and whole-cell tumor antigens are ongoing. Whereas ganglioside vaccines aim to stimulate a B-cell response, peptide vaccines are intended to stimulate T-cell based responses to tumor-specific antigens expressed on the surface of cells through a major histocompatibility complex class-I restricted process.

The NCCN recommends that patients with melanomas 4.0 mm be offered melanoma vaccine clinical trials. Ultimately, the goal is to develop an effective vaccine with a low toxicity that can be given to those at high risk for melanoma or administered to those with high risk of recurrence of melanoma after surgical resection.

Although new treatments are in the pipeline, “it is critical that ENTs be vigilant when it comes to identifying patients with skin cancers, especially high-risk skin cancers, on the head and neck,” said Dr. Weber. “Some of the signs and symptoms of certain skin cancers are subtle, so you should always ask your patients during the exam if they have noticed anything unusual on the skin of their head and neck and scalp; otherwise, they might not mention it or you might miss it.”

Identifying Skin Cancers on the Head and Neck

• Basal cell carcinoma (BCC) appears as a small, slow-growing pale patch of skin that produces a central “dimple” and eventually an ulcer that may scab over and then reulcerate; some BCCs show color changes. Although most BCCs do not metastasize, 35% to 50% of people diagnosed with one BCC will develop a new skin cancer within five years, according to the ACS.
• Squamous cell carcinoma (SCC) is similar in presentation, but tends to be more aggressive and have greater metastatic potential. It may start as actinic keratoses (AK), a precancerous lesion caused by too much sun exposure that appears as a small pink or flesh-colored rough spot on the skin. Bowen disease is SCC in situ and is larger, redder, and more scaly and crusty in appearance. Areas of SCC do not heal and can become open sores.
• About 111,900 new cases of melanoma will be diagnosed in 2006, representing almost a 10% increase since 2005, estimates the American Academy of Dermatology (AAD). Melanomas typically produce dense blue or black discolorations of the skin, like moles, and readily metastasize. If these pigmented lesions change in size or color or begin to bleed, it may signify trouble. (See “ABCDs of Melanoma” for more information on identifying these skin lesions.)
• Melanomas on the scalp may be hidden by hair and easily overlooked, as can those that are non-pigmented. Merkel cell carcinoma, which is a rare non-melanoma skin cancer that generally occurs in older patients and appears pink without pigment, may also be missed.

ABCDs of Melanoma

Asymmetry: One half of a mole is different from the other.