Early stages of head and neck melanoma

Melanom je maligni tumor koji nastaje zloćudnom preobrazbom pigmentnih stanica melanocita, a karakterizira ga agresivan rast i velika sklonost ranom širenju limfogenim i hematogenim putem. Gotovo 20% ukupnog broja melanoma javlja se u području glave i vrata, gdje se osim na koži, mogu pojaviti i na sluznicama, srednjoj očnoj ovojnici, te mekim moždanim ovojnicama.Unatoč činjenici da melanom čini tek 4 - 5% svih karcinoma kože, procjenjuje se da 71 - 80% smrtnosti od raka kože otpada upravo na njega. S obzirom na povećanje incidencije melanoma i rast stope mortaliteta zabilježene posljednjih nekoliko godina, neizmjerna je važnost identifikacije bolesti u ranim stadijima. Pod ranim stadijem melanoma podrazumijeva se lokalizirana bolest, odnosno postojanje primarnog tumora bez regionalne limfne i udaljene metastatske bolesti. Prema 8. revidiranom izdanju AJCC sustava za stupnjevanje melanoma, u kategoriji T (primarni tumor) najvažniji su pokazatelji ishoda debljina tumora, i postojanje ulceracije. Odluka o obavljanju biopsije limfnog čvora stražara (eng. sentinel lymph node biopsy – SLN) izuzetno je važna jer prisutnost regionalnih metastaza u limfnim čvorovima predstavlja najznačajniji prognostički čimbenik u ranim stadijima melanoma. Istraživanja su pokazala da bolesnici s melanomom kože glave i vrata imaju znatno kraće preživljenje u odnosu na bolesnike s melanomom drugih dijelova tijela, a primarna lokalizacija melanoma na vlasištu povezana je s najvećom stopom recidiva bolesti i znatno lošijom prognozom u usporedbi s ostalim kožnim lokalizacijama. Primarno liječenje ranih stadija melanoma kože glave i vrata je kirurško, a stope preživljavanja su visoke, međutim pojavom metastaza stopa preživljavanja značajno opada. Upravo je iz tog razloga rana dijagnoza ključna za osiguravanje najboljeg mogućeg ishoda bolesnika. Bolesnici u kojih se razvio melanom glave i vrata u većem su riziku od pojave povrata lokalne bolesti i razvoja drugog primarnog tumora, stoga su praćenje i klinički nadzor takvih bolesnika ključni za dobru prognozu.Melanoma is a malignant tumor caused by malignant transformation of pigment-forming cells known as melanocytes, and is characterized by aggresive growth and a high tendency for early lymphatic and hematogenous spread. Almost 20% of the total number of melanoma occurs on the head and neck, where it can appear on the skin, mucous membranes, uvea and leptomeninges. Despite the fact that melanoma accounts for only 4-5% of all skin cancers, it is estimated that 71-80% of skin cancer deaths are caused by it. Given the increased incidence of melanoma and the persistently high mortality rates recorded in recent years, the importance of identifying the disease in its early stages is crucial. Early stages of melanoma are defined as a localized disease, which refers to the existence of a primary tumor without the existence of regional lymphatic and distant metastatic disease. According to the 8th revised edition of the AJCC melanoma staging system, in category T (primary tumor) the most important outcome indicators are tumor thickness, the presence of ulceration. The decision to perform a SLN biopsy is extremely important because the presence of metastases in regional lymph nodes is the most significant prognostic factor in the early stages of melanoma. Studies have shown that patients with melanoma on the head and neck have significantly lower survival rates than patients with melanoma on other localizations, and the primary localization of melanoma on the scalp is associated with the highest recurrence rate and significantly worse prognosis compared to other localizations. The primary treatment for early stage melanoma of the head and neck is surgical, and survival rates are high, however, with the onset of metastases, the survival rate declines significantly. It is for this reason that early and accurate diagnosis is the key to ensure the best possible outcome for patients. Patients who have developed head and neck melanoma are at higher risk of recurrence of local disease and development of another primary tumor so follow-up and clinical monitoring of such patients are essential for a good prognosis