Operative Techniques in Otolaryngology - Head and Neck Surgery最新文献

Reconstruction of melanoma defects: Regional and free flaps 黑色素瘤缺损的重建：区域皮瓣和自由皮瓣

Operative Techniques in Otolaryngology - Head and Neck Surgery Pub Date : 2026-03-01 Epub Date: 2026-02-23 DOI: 10.1016/j.otot.2026.02.011

Hayden Guidry MD, Sukh S. Aulakh MD, Marianne Abouyared MD

引用次数: 0

Head and neck melanoma surveillance and survivorship 头颈部黑色素瘤的监测和存活

Operative Techniques in Otolaryngology - Head and Neck Surgery Pub Date : 2026-03-01 Epub Date: 2026-02-20 DOI: 10.1016/j.otot.2026.02.014

Michael McGlone MD , Jason Ohlstein MD , Chetan Nayak MD

{"title":"Head and neck melanoma surveillance and survivorship","authors":"Michael McGlone MD , Jason Ohlstein MD , Chetan Nayak MD","doi":"10.1016/j.otot.2026.02.014","DOIUrl":"10.1016/j.otot.2026.02.014","url":null,"abstract":"<div><div>Surveillance following treatment of cutaneous melanoma of the head and neck is essential for early detection of local, regional, and distant recurrence. Current surveillance recommendations are largely derived from generalized cutaneous melanoma guidelines; however, the head and neck region present unique challenges due to complex anatomy, variable lymphatic drainage, subsite-specific tumor biology, and the frequent need for reconstructive surgery. These factors contribute to higher recurrence rates, unpredictable metastatic patterns, and limitations of clinical examination alone. Certain subsites, particularly the scalp, demonstrate disproportionately high rates of recurrence and melanoma-specific mortality, even in the setting of negative sentinel lymph node biopsy. Additionally, lymphatic drainage to clinically occult nodal basins, including the parotid region, and higher false-negative rates of sentinel lymph node biopsy necessitate heightened vigilance. Imaging plays a critical adjunctive role in surveillance, with ultrasound offering superior sensitivity and specificity for regional nodal recurrence, while PET-CT is most valuable for detection of distant metastasis and evaluation of anatomically distorted postoperative fields. Surgical reconstruction further complicates surveillance by obscuring recurrence and altering native margins, underscoring the need for a low threshold for biopsy of suspicious findings. Given these complexities and the limited head and neck–specific evidence base, surveillance strategies should be individualized, integrating general melanoma guidelines with region-specific risk factors, tumor characteristics, and reconstructive considerations. Further research is needed to establish evidence-based surveillance protocols tailored specifically to cutaneous melanoma of the head and neck.</div></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"37 1","pages":"Pages 101-104"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cutaneous melanoma sentinel node biopsy: Target patient population, technique, and management of positive results 皮肤黑色素瘤前哨淋巴结活检：目标患者人群、技术和阳性结果的管理

Operative Techniques in Otolaryngology - Head and Neck Surgery Pub Date : 2026-03-01 Epub Date: 2026-02-18 DOI: 10.1016/j.otot.2026.02.008

Pragnya Dontu MD , Robert Duncheskie BS , Cecelia E. Schmalbach MD, FACS

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Special circumstances in the management of melanoma: Recurrence, metastasis, and nonsurgical approaches 黑素瘤治疗中的特殊情况：复发、转移和非手术方法

Operative Techniques in Otolaryngology - Head and Neck Surgery Pub Date : 2026-03-01 Epub Date: 2026-02-19 DOI: 10.1016/j.otot.2026.02.013

Abdullah Bin Naveed MBBS , Rizwan Aslam DO, MS, MBA, MPH, FACS

{"title":"Special circumstances in the management of melanoma: Recurrence, metastasis, and nonsurgical approaches","authors":"Abdullah Bin Naveed MBBS , Rizwan Aslam DO, MS, MBA, MPH, FACS","doi":"10.1016/j.otot.2026.02.013","DOIUrl":"10.1016/j.otot.2026.02.013","url":null,"abstract":"<div><div>While the primary treatment of cutaneous melanoma in the head and neck region is often straightforward, clinicians frequently encounter complex scenarios that require nuanced management strategies. This chapter addresses special circumstances in melanoma care, specifically focusing on disease recurrence, metastatic progression, and treatment alternatives for poor surgical candidates. It begins by outlining the patterns of recurrence and the appropriate surveillance and intervention strategies for local, regional, and distant relapse. The discussion then shifts to the management of metastatic disease, reviewing current paradigms in systemic therapy—including immunotherapy and targeted agents—and the role of metastasectomy. Finally, the chapter evaluates nonoperative approaches for patients who are unable to undergo surgery due to comorbidities or anatomical constraints, exploring modalities such as radiation therapy and intralesional treatments. This overview provides a framework for decision-making in these challenging clinical presentations.</div></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"37 1","pages":"Pages 91-100"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Recent updates in the management of cutaneous melanoma of the head and neck 头颈部皮肤黑色素瘤治疗的最新进展

Operative Techniques in Otolaryngology - Head and Neck Surgery Pub Date : 2026-03-01 Epub Date: 2026-02-17 DOI: 10.1016/j.otot.2026.02.005

Alexander Karabachev MD , Ryan N. Hellums DO , Alice Tang MD , Dustin Silverman MD , Chad Zender MD , Priscilla F.A. Pichardo DO

{"title":"Recent updates in the management of cutaneous melanoma of the head and neck","authors":"Alexander Karabachev MD , Ryan N. Hellums DO , Alice Tang MD , Dustin Silverman MD , Chad Zender MD , Priscilla F.A. Pichardo DO","doi":"10.1016/j.otot.2026.02.005","DOIUrl":"10.1016/j.otot.2026.02.005","url":null,"abstract":"<div><div>To summarize recent developments in staging and treatment strategies for cutaneous melanoma of the head and neck, emphasizing the impact of sentinel lymph node biopsy (SLNB) and immunotherapy on patient outcomes. A narrative review of pivotal clinical trials and guideline updates was conducted, focusing on surgical, staging, and systemic management of head and neck cutaneous melanoma. Key trials informing current National Comprehensive Cancer Network (NCCN) and American Joint Committee on Cancer (AJCC) recommendations were reviewed. The AJCC 8th edition refined staging parameters, emphasizing Breslow thickness, ulceration, and clinically occult nodal disease identified by SLNB. Landmark trials, including MSLT-I, DeCOG-SLT, and MSLT-II, demonstrated that SLNB provides essential prognostic information without a survival benefit from completion lymph node dissection (CLND). Recent data from neoadjuvant immunotherapy trials including SWOG S1801, OpACIN, and PRADO support the use of checkpoint inhibitors such as pembrolizumab and nivolumab in resectable high-risk disease. Pathologic response-based de-escalation of surgery and adjuvant therapy has emerged as a safe and effective approach, reducing morbidity while maintaining oncologic control. Advances in melanoma staging and immunotherapy have transformed the management of head and neck disease. SLNB remains a cornerstone for accurate prognostication, while neoadjuvant and adjuvant immunotherapy strategies allow individualized, less invasive, and more effective treatment. Continued integration of molecular and pathologic response data promises to further refine personalized care for patients with head and neck melanoma.</div></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"37 1","pages":"Pages 21-26"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

“Workup of Melanoma. Biopsy technique (punch, incisional, tangential), and imaging” “黑色素瘤的检查。活检技术（穿孔、切口、切向）和成像

Operative Techniques in Otolaryngology - Head and Neck Surgery Pub Date : 2026-03-01 Epub Date: 2026-02-17 DOI: 10.1016/j.otot.2026.02.003

Alice G. Matthai MD, Joseph A. Blansfield MD

引用次数: 0

Head and neck melanoma: Wide local excision and margin assessment 头颈部黑色素瘤：广泛局部切除和边缘评估

Operative Techniques in Otolaryngology - Head and Neck Surgery Pub Date : 2026-03-01 Epub Date: 2026-02-26 DOI: 10.1016/j.otot.2026.02.006

Anas M. Qatanani MD , Randy W. Lesh MD , Kevin J. Kovatch MD , Phillip K. Pellitteri DO, FACS

{"title":"Head and neck melanoma: Wide local excision and margin assessment","authors":"Anas M. Qatanani MD , Randy W. Lesh MD , Kevin J. Kovatch MD , Phillip K. Pellitteri DO, FACS","doi":"10.1016/j.otot.2026.02.006","DOIUrl":"10.1016/j.otot.2026.02.006","url":null,"abstract":"<div><div>Melanoma accounts for the majority of skin cancer-related mortality and continues to demonstrate rising incidence. Nearly one-quarter of melanomas arise in the head and neck, where complex anatomy presents unique challenges for diagnosis, staging, and surgical management. Accurate characterization of melanoma subtype and stage, guided primarily by Breslow thickness and the American Joint Committee on Cancer 8th Edition Tumor, Node, Metastasis system, is critical for determining appropriate surgical margins and the need for sentinel lymph node biopsy. Curative-intent treatment centers on complete surgical excision with histologically negative margins. However, achieving adequate margins in the head and neck requires balancing oncologic control with preservation of function and aesthetics. Wide local excision and Mohs micrographic surgery represent the 2 main surgical approaches, with growing evidence supporting tissue-sparing strategies in carefully selected cases. General surgical principles include the use of beveled excisions to address adnexal spread, while site-specific techniques are often required for lesions adjacent to critical structures, including the eyes, nose, lips, ears, and scalp. Intraoperative margin assessment with frozen sections using melanoma antigen recognized by T cells immunohistochemistry offers high reliability, though permanent histopathology remains the diagnostic standard. Reconstruction is frequently delayed until margins are confirmed, but may be performed immediately in low-risk scenarios where the likelihood of positive margins is minimal. Management of head and neck melanoma, therefore, requires an individualized approach that integrates tumor characteristics, anatomic considerations, and reconstructive planning to optimize oncologic, functional, and aesthetic outcomes.</div></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"37 1","pages":"Pages 27-33"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Introduction/Foreword 介绍/前言

Operative Techniques in Otolaryngology - Head and Neck Surgery Pub Date : 2026-03-01 Epub Date: 2026-02-28 DOI: 10.1016/j.otot.2026.02.002

Nicholas C. Purdy DO FACS (Guest Editor)

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Adjuvant and neoadjuvant treatment for melanoma: integrating immunotherapy, radiation and systemic therapies into surgical practice 黑色素瘤的辅助和新辅助治疗：将免疫治疗、放射治疗和全身治疗纳入手术实践

Operative Techniques in Otolaryngology - Head and Neck Surgery Pub Date : 2026-03-01 Epub Date: 2026-02-26 DOI: 10.1016/j.otot.2026.02.015

Fergal G Kavanagh MB, BCh, PhD, Luc G Morris MD

{"title":"Adjuvant and neoadjuvant treatment for melanoma: integrating immunotherapy, radiation and systemic therapies into surgical practice","authors":"Fergal G Kavanagh MB, BCh, PhD, Luc G Morris MD","doi":"10.1016/j.otot.2026.02.015","DOIUrl":"10.1016/j.otot.2026.02.015","url":null,"abstract":"<div><div>Systemic therapies have transformed melanoma care, delivering durable responses and survival benefits in metastatic and resected high-risk disease. Immune checkpoint inhibitors—particularly antiprogrammed death 1 agents—have replaced interferon-based regimens as the foundation of adjuvant therapy. Here, we summarize the evolution of systemic and adjuvant therapies for melanoma, with an emphasis on immune checkpoint inhibition, BRAF/MEK-targeted therapy, and emerging treatment strategies. Targeted therapies, especially BRAF/MEK inhibitors, provide rapid tumor regression and now play a defined role in metastatic and adjuvant settings for BRAF-mutant melanoma. The most exciting recent development is the discovery of neoadjuvant immunotherapy as superior to adjuvant alone in clinically detectable stage III disease, reshaping treatment algorithms and standard of care. The adjuvant landscape in melanoma has transformed care and outcomes dramatically in the last two decades and continues to evolve. Overcoming resistance and refining treatment sequencing remain key to expanding durable benefit and improving long-term outcomes.</div></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"37 1","pages":"Pages 71-78"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Mucosal melanoma of the head and neck 头颈部粘膜黑色素瘤

Operative Techniques in Otolaryngology - Head and Neck Surgery Pub Date : 2026-03-01 Epub Date: 2026-02-17 DOI: 10.1016/j.otot.2026.02.012

Pallavi Kulkarni MD , Kunal Koka BS , Emily K. Funk MD

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