Cutaneous Head and Neck Melanoma: Advances in Diagnosis and Management

Dear Colleagues,

Cutaneous head and neck melanoma (HNM) has increasingly been characterized as a biologically distinct clinicopathologic entity. Compared to its counterparts on the trunk and extremities, this entity exhibits unique genetic profile and biological behavior, driven by chronic ultraviolet damage and characterized by a high tumor mutational burden (TMB), sometimes multifocal and heterogeneous mixed histologic subtype disease, and a notable sensitivity to modern immunotherapy.

Managing HNM necessitates an individualized, interdisciplinary approach that balances the specific biologic potential of the lesion with patient-specific factors such as age and comorbidities. Pure in situ disease of the lentigo maligna subtype poses a unique therapeutic challenge due to its low malignant potential despite the frequent presence of subclinical extension and adnexal involvement and its predilection for presentation in an aging population. In invasive lesions, the presence of a broad peripheral in situ component, often encompassing a large surface area, poses its own distinct management challenges. Thus, clinicians must balance overall oncologic risk with anatomical and functional considerations, a pervasive "field effect," and background actinic damage that can obscure histologic margin evaluation.

This Special Issue will synthesize the latest evidence regarding the efficacy of various techniques (including next-generation techniques) for margin-controlled surgery, non-invasive tools for pre-operative surgical mapping, indications (and pitfalls) for non-surgical treatment modalities, and the integration and expanding role of systemic therapies in treatment of cutaneous HNM. We invite you to contribute to this Special Issue, dedicated to advancements in the multifaceted prognostic and therapeutic considerations of cutaneous head and neck melanoma. Original research articles and reviews are both welcome. Research areas may include (but are not limited to) the following:

• Novel Optical Imaging: The utility of in vivo RCM, OCT, and LC-OCT for mapping HNM and performing "optical biopsies."
• Surgical Innovation: Comparative studies of Mohs micrographic surgery (with MART-1) vs. staged excision and its role for in situ and invasive disease, and the implementation of rapid immunostaining protocols.
• Intraoperative Margin Control: Clinical utility of Ex Vivo Confocal Microscopy for real-time assessment of peripheral and deep margins.
• Nodal Staging and Risk Stratification: The evolving role of Gene Expression Profiling (GEP) in the decision to perform Sentinel Lymph Node Biopsy (SLNB), addressing the "sentinel node paradox" and the impact of complex lymphatic drainage on staging accuracy in H&N sites.
• Pathology and Biomarkers: The prognostic significance of neurotropism/perineural invasion (PNI) and the role of PRAME and AI-standardized TIL quantification in H&N sites.
• Non-Surgical Modalities: The role of imiquimod, radiotherapy, and combination therapies, specifically addressing patterns of failure and recurrence in the setting of field cancerization.
• Systemic Therapy: Integration of neoadjuvant immunotherapy in locally advanced HNM and the predictive value of TMB for ICI response.
• Reconstruction: Functional and patient-reported outcomes following complex facial unit reconstruction post-melanoma excision.

I look forward to receiving your contributions.

Dr. Shirin Bajaj
Guest Editor

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