Melanotic and non-melanotic malignancies of the face and external ear – A review of current treatment concepts and future options

• Published in: Cancer treatment reviews Vol. 40; no. 7; pp. 819 - 837
• Main Authors: Kolk, Andreas, Wolff, Klaus-Dietrich, Smeets, Ralf, Kesting, Marco, Hein, Rüdiger, Eckert, Alexander W
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.08.2014; Elsevier
• Subjects: Antineoplastic agents; Biological and medical sciences; Dermatology; Ear, External - pathology; Early Detection of Cancer; Facial Neoplasms - pathology; Facial Neoplasms - therapy; Facial skin cancer; Future treatment concepts; Hematology, Oncology and Palliative Medicine; Humans; Medical sciences; Melanoma - pathology; Melanoma - therapy; Multimodal treatment; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; Pharmacology. Drug treatments; Reconstruction; Skin Diseases - pathology; Skin Diseases - therapy; Skin Neoplasms - pathology; Skin Neoplasms - therapy; Tumors; Tumors of the skin and soft tissue. Premalignant lesions; Multimodal treatment; Reconstruction; Future treatment concepts; Facial skin cancer; Skin disease; Malignancy; Review; Malignant tumor; Skin cancer; Treatment; Ear; External; ENT disease; Head and neck cancer; Skin; Face; Bibliographic review; Cancer
• ISSN: 0305-7372; 1532-1967
• DOI: 10.1016/j.ctrv.2014.04.002

Abstract Skin has the highest incidence and variety of tumors of all organs. Its structure is of great complexity, and every component has the potential to originate a skin neoplasm (SN). Because of its exposed nature, skin is vulnerable to carcinogenic stimuli such as UV radiation. Various entities can cause SN. Nonmelanotic skin cancers (NMSC) are the most common of all cancers, with over one million cases diagnosed annually in the US. Basal cell carcinoma (BCC) accounts for approximately 80% of all NMSC, most of the remaining 20% being squamous cell carcinoma (SCC). The skin of the head and neck is the most common site for tumors, accounting for more than 80% of all NMSC. BCC, SCC, and malignant melanomas (MM) represent 85–90% of all SN. Merkel cell tumors (MCC), lymphoepithelioma-like carcinomas of the skin (LELCS), dermato-fibro-sarcomas, leiomyosarkomas, and Kaposi-sarcomas are less frequent in the facial skin region and the external ear. Based on data from the German Federal Cancer Registry (2003/2004), 140,000 people in Germany were affected by SN (100,000 BCC, 22,000 SCC, 22,000 MM). This number increases considerably if malignant precursors, such as actinic keratosis, are included. Each year, the frequency of SN diagnosis rises by 3–7%. Among all known malignant tumors, MM exhibits the highest rate of increase in incidence. In the past, SN was primarily diagnosed in people aged 50 years or older. However, recently, the risk for developing SN has shifted, and younger people are also affected. Early diagnosis is significantly correlated with prognosis. Resection of SN creates defects that must be closed with local or microvascular flaps to avoid functional disturbing scar formation and deflection of the nose, eyelids, or lips. All therapeutic strategies for SN, the current standard for adjuvant and systemic treatment, and the management of the increasing number of patients under permanent blood thinner medication are described with regard to the treatment of SN.