Skin cancers of face and head : a review on current and future treatment options

The authors reviewed the current and future treatment options for different types of skin cancers in the face and head. 

Skin cancer is the most common type of cancer. Based on where in the skin the cancer grows, skin cancer can be melanotic or non–melanotic. Melanotic skin cancer (melanoma) grows in the color producing cells of the skin. Non–melanotic skin cancers (NMSC) grow in the squamous cells (flat cells in the outer part of the top layer of the skin), known as squamous–cell carcinoma (SCC).

It can also grow in the basal cells (cells in the lower part of the top layer of the skin), known as basal-cell carcinoma (BCC). BCC accounts for 80% of all NMSC. The most common sites for NMSC are the skin of the face, head and neck, affecting almost 80% of all NMSC. 

The authors aimed to review risk factors, current and future treatment options available for different types of skin cancers affecting the face and head.

BCC:

Complete surgical removal of the tumor is the primary treatment used to treat BCC. Micrographic surgery (removing the tumor one layer at a time and examining the layers immediately) can also be performed. In a study of 408 patients with first occurrence of BCC and 204 recurrent BCC patients (return of cancer), the recurrence rate was 3% in complete surgery and 2% in micrographic surgery.

When surgery is not suitable for patients, laser therapy (treatment by light), cryotherapy (using extreme cold to kill tumor cells) or photodynamic therapy (treatment by light and special drugs to kill cancer cells) can be used. Photodynamic therapy has a 60% favorable aesthetic result compared to 16% after cryotherapy. The 5-year recurrence rate was almost the same for cryotherapy (20%) and photodynamic therapy (22%). Based on several studies, the overall recurrence rate of BCC was 5%. 

Ingenol mebutate (Picato) is an emerging gel therapy that could be a promising treatment option for BCC which has not grown too deeply into the skin. Due to the recurrence rate of BCC (5%) and the risk of new tumor growth (30%), life-long follow-up is recommended.

SCC:

Standard treatments for SCC include surgical removal of the tumor and micrographic surgery. Surgery using wide excisions (tissue is removed until there is no cancer remaining at the site or in surrounding tissues) reduces the risk of local cancer recurrence from 30.8% to 9.1%.

Polychemotherapy (chemotherapy using a number of different drugs) and radiation therapy (directs a beam of radiation at the tumor site in order to kill cancer cells) can also be used to treat SCC. 

Surgery combined with radiation therapy resulted in a disease-specific survival rate (patients who did not die from SCC) of 70 to 75% over 5-years. When the cancer spread to other parts of the body (metastasis), the rate decreased to 30%.

Melanoma:

Surgical removal of the tumor is the primary treatment option used in melanoma. Based on studies, the 5-year melanoma-specific survival (patients who did not die from melanoma following treatment) was 85% when melanoma was restricted to the original site. The rate decreased to 30% when melanoma spread to nearby lymph nodes (tiny, bean-shaped organs that help fight infections). Patients who have a risk of cancer spread or ulceration can be treated with an interferon-alpha (Intron A, Roferon) (protein that fights infection) chemotherapy which may increase survival rates.

Radiation and cryotherapy are alternate treatment options when surgery is not possible. Immunotherapy (treatment that uses the body’s own immune system to fight cancer) could be another promising treatment. In a recent study with ipilimumab (Yervoy), an immunotherapy, the average overall survival of advanced melanoma patients was 10.1 months compared to 6.4 months in the control group.

The authors concluded that surgery is the preferred treatment for skin cancers of the face and neck. Chemotherapy, radiation therapy and cryotherapy are some of the other treatment options.