Rare head and neck tumors II

Approximately 20% of skin tumors occur in the head and neck region. The therapeutic procedure is laid down in the current interdisciplinary guidelines of the EBM on skin tumors (squamous epithelial carcinoma, melanoma, Merkel cell carcinoma and basal cell carcinoma). For mucous membrane tumors primary R0 surgery is recommended. Approximately 57% of Merkel cell carcinomas occur in the head and neck region. Bilateral selective neck dissection and adjuvant radiation therapy is recommended for every stage. Operative therapy with histological confirmation is the standard procedure for treatment of basal cell carcinoma. The therapeutic procedure for squamous epithelial carcinoma depends on the extent and the histological subtype of the tumor. Complete surgical excision with topographically assigned histopathological control of the incision edges is the first choice treatment as long as this is medically acceptable. Malignant growths in the region of the nasal and paranasal cavities form approximately 4% of head and neck tumors. The general therapeutic principles depend on the possibility of complete resection of the tumor. Postoperative radiation and chemotherapy should be carried out depending on experience with other head and neck tumors in a pT3/4 situation. A dilemma with rare soft tissue sarcomas with many histological subtypes is that at present there is no appropriate classification for this group of tumors. In addition there are no guidelines or evidence with respect to indications for resection of residues after primary chemotherapy of pediatric rhabdomyosarcoma-like tumors. It is therefore recommended that these tumors should be treated in interdisciplinary oncology centers. Small cell carcinomas are highly malignant and rapidly form metastases. The therapy of small cell carcinomas in the head and neck region depend on the localization, tumor spread, lymph node status and the presence of distant metastases.