1. STATEMENTS 2008 on Head and Neck Cancer Stephane TEMAM, M.D. PhD. Department of Head and Neck Surgery Mucosal Melanoma

2. EPIDEMIOLOGY A rare disease <1% all melanoma >50% of MM are in the head and neck Incidence remained stable ♂ > ♀ 7th decade

3. DIAGNOSIS Pigmented mucosal lesions Primary vs. metastasis –Pathological characteristics (IHC) –Precursor lesions

4. STAGING and WORKUP AJCC 2002 TNM classification is not accurate because almost all patients are T4b (>4 mm in thickness) A total body skin examination CT-Scan / MRI of the head and neck DM –CT-Scan / PET: brain, chest, abdomen, pelvis –Serum lactate dehydrogenase

5. Sites Nose and paranasal sinuses Oral cavity –Hard palate and maxillary alveolus Other sites : rare

6. Surgery Radical and wide surgical resection Controversies –How large (2cm margins) : anatomical and functional limitations as SCC –Extensive In Situ melanosis –Systematic treatment of the neck or SNB for staging for oral melanoma –Therapeutic neck dissection is questionable

7. Survival Recent reports: –Local control rate : 29% to 52% –5-year overall survival rate : 20% to 35% –Long term survival patients –DM 47% to 62% associated with Local relapse Positive neck nodes #100%

8. Radiotherapy In vitro: a high capacity for repair of sublethal DNA-damage  radioresistance Hypofractionation (dose/fraction>4Gy) recommended on a large non-randomized study, but not confirmed on a small size PIII RTOG trial for cutaneous M Limitation : proximity to the optical structures and the central nervous system.

9. Radiotherapy Improve local control after surgery Indicated for unresecable disease Unresolved questions –Elective nodal irradiation –Total dose and Fractionation –New modalities : volume, neutron, proton –Use of chemotherapy and possibly new target therapy in concomittent or adjuvant setting

10. Systemic treatment Palliative setting But also as adjuvant treatment for advanced stages –Cutaneous melanoma protocols –But different biology: cGH-arrays  distinct sets of genetic alterations