Uncommon Cutaneous Neoplasms of the Head and Neck

Malignant cutaneous adnexal tumours of the head and neck: an update on management

“…[5][6][7][8] In patients having psoralen-UV treatment for psoriasis its incidence is about 100 times higher than that seen in the general population, which indicates that both UVA and UVB radiation have a role. 9 Viral infection could also be an important factor. 10 A new virus, Merkel cell polyomavirus (MCPyV) has been found in 80% of patients over 50, 11 and although little is known about transmission and latency, its prevalence in MCC lesions has been reported to range from 40% to 100%.…”

“…[17][18][19][20] Operation is the primary treatment. 9 Some surgeons support the use of wide excision margins (1-2 cm), and Mohs micrographic surgery (MMS) has been suggested as a viable alternative as local recurrence rates were comparable to those after wide excision. 21 Further treatment depends on the route In situ primary tumour T1 Primary tumour less than 2 cm T2 Primary tumour more than 2 cm but less than 5 cm T3 Primary tumour more than 5 cm T4…”

“…Management consists of resection either with wide excision or MMS. 9 Although specific measurements have not been set to ensure that margins are clear, it is generally accepted that 2 cm is required around the tumour. Magnetic resonance (MR) and other types of imaging can be used when tumours are likely to have penetrated deeply.…”

“…Recurrence after wide excision occurs in around 10% of cases, and margins of 1-2 cm with the deep margin deep to the fascial plane, are recommended. 9 It was recently shown that recurrence is less likely if safety margins are wider than 2 cm, 53 and it is reduced if MMS is used because of the subclinical extension outside normal excision margins. 54 If it does recur, particularly within 6 months, some authors suggest prompt surgical re-excision, sentinel lymph node biopsy (SLNB), and radiographic staging for systemic disease.…”

“…Extraocular tumours are more likely to display intraepithelial spread. 9 If sebaceous carcinoma is diagnosed, it is important to evaluate patients for Muir-Torre syndrome. This is an autosomal dominant geno-dermatosis which has mutations in the MLH1 and MSH2 genes involved in DNA mismatch repair.…”