Head and Neck Skin

Skin cancer rates in Switzerland are among the highest internationally. This is due to the intense ultraviolet (UV) radiation in the mountains and near water, as well as the leisure and travel activities of people living in Switzerland. Skin cancer often develops on the head and neck, which is related to the fact that the skin in these areas is exposed to particularly high levels of UV radiation over the course of a lifetime.

In skin cancer, a primary distinction is made between melanoma and non-melanoma skin cancer, with the latter being divided into basal cell carcinoma and cutaneous squamous cell carcinoma. In addition, there are other, significantly rarer types of skin cancer such as Merkel cell carcinoma. • Basal cell carcinomas are the most common type of skin cancer and the most common cancer overall. Their behaviour is typically slow-growing and locally destructive, but they almost never form metastases. Treatment consists of complete surgical removal with clear margins; in cases where surgery is not an option, radiotherapy may also be used. For cases where neither surgery nor radiation is possible, special medications are available. • Cutaneous squamous cell carcinomas are the second most common type of skin cancer. A large proportion of these tumours also grows relatively slowly and can therefore be diagnosed early and treated well. However, 5 to 10% of these tumours behave aggressively, grow rapidly, and form metastases, most commonly in the parotid gland and the cervical lymph nodes. These patients with high-risk tumours must be identified early during evaluation and treated appropriately, usually with surgery followed by radiotherapy. In cases where this is not possible or no response is observed, modern medications (immunotherapies) are available. • Malignant melanoma is one of the most dangerous types of skin cancer and can form metastases early in its course. Melanomas must therefore be removed with a wider safety margin than white skin cancer. Additionally, beyond a certain depth of invasion (tumour growth into deeper layers), the regional lymph nodes in the drainage area of the tumour must be included in treatment. This is done either through a so-called sentinel lymph node biopsy if no metastases are present (but there is a risk of them), or through lymph node dissection in the case of confirmed metastases (depending on the drainage area, consisting of a parotidectomy (partial removal of the parotid gland) and/or a neck dissection). In advanced melanomas or in cases of confirmed metastases, follow-up treatment with medications is usually required after surgery.

It is very understandable that patients are concerned about scars as well as the cosmetic and functional outcome after the removal of a skin tumour. Fortunately, defects in the neck and facial area can be reconstructed very well, so that usually an appealing result is already visible after a few weeks. In certain locations, such as the wing of the nose, a multi-stage approach, i.e., reconstruction in several steps, or a secondary correction may be necessary. We will establish an individual treatment plan with you that also takes your preferences for reconstruction into account.

Metastases are most common in melanoma and high-risk squamous cell carcinomas of the skin. Basal cell carcinomas almost never form metastases. However, there are other, rarer types of skin cancer, such as Merkel cell carcinoma, that can also metastasize. Lymph node metastases can manifest as a lump in the parotid gland (in front of the ear or at the jaw angle) or in the neck, which is further evaluated using an ultrasound-guided fine-needle aspiration. In tumours with a high risk of metastasis, such as melanoma, metastases consisting of just a few cells can be detected through the so-called sentinel lymph node biopsy.

A sentinel lymph node biopsy is a procedure in which metastases consisting of even a small cluster of individual cells in the lymph nodes can be detected using specialized tissue examination methods. It is used for melanoma as well as other types of skin cancer, such as Merkel cell carcinoma or lip carcinoma. Before the surgery, a slightly radioactive substance (the so-called tracer) is injected around the tumour and the first lymph nodes in the drainage area are then visualized using specialized medical imaging techniques. These nodes can be located and removed during surgery using a gamma probe. If the sentinel lymph nodes are tumour-free, it can be assumed that no metastases are present. Otherwise, additional treatment is necessary to reduce the risk of recurrence.