Melanoma is the most serious form of skin cancer. It begins in the pigmented cells of the skin but, for head and neck melanomas, it can also start in the sinuses in the head or the mouth. It behaves very differently from other cancers of the head and neck. Some of the other cancers of the head and neck begin in the skin, but many begin inside the mouth see such as the tongue, the back of the throat, the tonsils or the larynx. Many are associated with alcohol and smoking whereas melanoma is often associated with sun exposure. The other cancers frequently spread to the neck glands first; melanomas may do that but they also can skip these areas and go elsewhere— the skin, the liver, the lungs, the bone, the brain or other organs. The surgery needed to produce cure is very different than when a melanoma is in a different location. But some of the information needed to give people the best care are the same for all melanomas: be sure the tumor is melanoma under the microscope and know what type it is, know how deep the tumor is in the skin where the first or primary lesion occurred, know how may cells appear to be dividing and if the body’s immune cells are in the tumor, and and know if the top layer of the primary lesion is not present. This information guides us to know what kind of surgery is best and what our ability to produce a cure is. For melanomas on the skin, repeated exposure to the sun, especially if there are bad sunburns or no sunburn at all, increase your risk of sunburn. Melanomas can occur anywhere on the exposed skin. For these exposed areas, a hat and frequent application of sun screen is helpful to avoid the problem of melanoma later in life. Sometimes, the surgery needed to prevent local recurrence or to produce a cure requires a plastic surgeon to cover areas where the skin needs to be removed. At times, radiation is an important part of the therapy. Prior to this last year (2010), when disease had spread, these physicians had very few tools to help people, but in the last year there have been some very promising drugs now available to give people a better quality of life.
Each of the members of a melanoma tumor board can contribute their opinions about what is going on in an individual. There are many doctors in tumor boards and the combined opinions, discussed openly, will create a better opinion for how care is best than the opinions of any single individual physician. The drugs just being made available are more targeted drugs than the previous chemotherapy agents. Some, like ipilumumab, can produce significant problems for the patient but when they work, the responses are well worth it. There are also other new drugs, such as a drug that works against a material, B-raf, that your body is making to drive the cells to grow. The first drug of this type to reach the market is Vemurafenib. It will be some time before we know how to use these drugs properly but the promise is there. Remember though that the best way to prevent melanomas that begin on the skin of the head of the neck is to cover up with clothes, sun screen or both and avoid serious sun burns.