Treatment results of regional metastasis from cutaneous head and neck squamous cell carcinoma.

AIMS: To investigate the results of our treatment policy, we present our institutional experience in the management of regional neck node metastases of cutaneous head and neck squamous cell carcinoma (CHNSCC). METHODS: Between 1977 and 1997, 343 patients presented with CHNSCC, of whom 41 were treated for regional metastases, with parotidectomy and/or (selective) neck dissection. Histological analysis was performed on all operation specimens. Patients with multiple nodes and/or extra capsular rupture, at risk for recurrence, received adjuvant radiotherapy. RESULTS: Seventy-six percent of the regional metastases occurred within the first 2 years, but a delay of more than 5 years was also observed. Parotid gland (56%), neck levels II (39%) and V (22%) were most frequently involved. Twenty-four percent of patients treated with curative intent failed at the regional site. Five years overall survival was 46%, with a median survival of 49 months. No survival differences emerged between patients treated by surgery alone and patients receiving adjuvant radiotherapy (P=0.14). Five patients died of disease, of whom three with distant metastases. CONCLUSION: Regionally metastasized CHNSCC is a serious disease with a high risk of regional recurrence, calling for combined surgery and adjuvant radiotherapy. A small subset of patients with a long interval between completion of primary treatment and presence of regional nodes justifies a long follow-up.

Report of a symposium on: diagnosis and treatment of cutaneous head and neck melanoma.

A series of presentations and discussions was held during a symposium on the diagnosis and treatment of cutaneous head and neck melanoma. The purpose of this meeting was to define certain guidelines on diagnosis and treatment of head and neck melanoma. The results of this symposium are summarized and condensed in this report. Recommendations are made for diagnostic strategies and for treatment. It is indicated that research efforts in immunology need to be expanded to develop rational immunotherapy.

[Facial melanosis (melasma)]. / Melanosis faciei (melasma).

PIP: Case report of a 23-year-old nulliparous woman with facial melanosis manifesting itself as hyperpigmented, symmetrical areas which started during a sunny vacation is presented. Patient used oral contraceptives (Stedril-d or Ortho-Novum) for 2 years; no other drugs or cosmetics were used. Treatment with 5% hydroquinone, 0.1% triamcinolone acetonide, 0.5% tretinoin in equal parts, propyleneglycol, and ethanol 1-2 times daily for 3 months. Ortho-Novum was used during this period. No symptoms for 3 1/2 years, then recurrence after sunlight exposure. Patient used no "pill" at that time. Same treatment used with good results. Sunscreen (RV-paque) used for skin protection. Melasma consists of lightbrown to greyish sharply circumscribed, symmetrically localized spots. Histologically, increased melanin and some melanophages are found in dermal layers. Melasma is influenced by light and hormonal factors. Melanocyte-stimulating-hormone (MSH) promotes melanosome migration in dendrites coupled with skin darkening; it also activates tyrosinase. Progesterone acts on estrogen-primed melanocytes. These hormones play a role in "pill-melasma" which can occur after sunlight exposure. Melasma can result from a phototoxic or photoallergic reaction to cosmetics, tar, or other photosensitizing agents. We examined 74 patients (70 women and 4 men; ages 16-53 years) between 1973-1979. 15 patients were pregnant; 19 used the "pill" or other hormone therapy, 12 resulted from sunburn; there was no apparent cause in 26. Several depigmentation agents have been tested for treatment. Of these, hydroquinone had good results with minimal side effects. Mercaptamines were tested experimentally but not used therapeutically. 0.2% triamcinolone acetonide in cream base was satisfactory. Of 40 patients treated with either 5% hydroquinone, 0.5% tretinoin and 0.1% triamcinolone, or with corticosteroids only, 40% had good results with corticosteroids and 53% with the hydroquinone combination. Sunlight and cosmetics must be avoided and sunscreening agents used to prevent recurrence.^ieng