2018-19 Section 7-Neoplastic and Inflammatory Diseases of the Head and Neck eBook

ii. MSLT 1-2 Faries MB, Han D, Reintgen M, et al. Lymph node metastasis in melanoma: a debate on the significance of nodal metastases, conditional survival analysis and clinical trials. Clin Exp Metastasis . 2018; 35(5-6):431-442. EBM level 1.......................................................................63-74 Summary : This article discusses the benefit of completion lymphadenectomy after sentinel lymph nodes are found to be positive. Two hypotheses about the spread of melanoma are discussed: incubator and marker hypotheses. The incubator hypothesis is that lymph nodes provide a haven for melanoma to grow and increase in metastatic potential. For the incubator hypothesis, lymphadenectomy provides benefit by removing this metastatic potential. The marker hypothesis is that the lymph nodes are a marker of clinically occult distant metastases, and lymphadenectomy in this setting provides no benefit. The recent trials concerning the benefits of completion lymphadenectomy are reviewed. Schmalbach CE, Bradford CR. Completion lymphadenectomy for sentinel node positive cutaneous head & neck melanoma. Laryngoscope Investig Otolaryngol . 2018; 3(1):43-48. EBM level 1............................................................................................................................................75-80 Summary : This article reviews the most recent clinical trials evaluating completion lymphadenectomy for positive sentinel node biopsy. Although no head and neck–specific prospective trials have been performed, the non-prospective head and neck melanoma studies are reviewed, and the applicability of findings of the prospective trials to patients with head and neck melanoma are analyzed. Han AY, Patel PB, Anderson M, et al. Adjuvant radiation therapy improves patient survival in early-stage Merkel cell carcinoma: a 15-year single-institution study. Laryngoscope . 2018; 128(8):1862-1866. EBM level 4...................................................................................................81-85 Summary : This study was a retrospective review comparing 88 patients with Merkel cell carcinoma who were treated with surgery alone to those treated with surgery and postoperative radiotherapy to assess for differences in survival. Radiotherapy was not found to be a significant determinant of survival, but when restricted to stage I and II Merkel cell carcinoma (AJCC 7th edition), radiotherapy addition to surgery did significantly improve survival ( p = 0.019). Overall stage, T stage, N stage, and M stage all were found to significantly contribute to survival on univariate analysis. Patient age, gender, primary site, negative margin status, immunosuppression, and history of prior malignancy were not found to significantly contribute to overall survival.

B. Non melanoma skin cancer i. Merkel cell