Head and neck cutaneous melanoma: New insights in diagnostics and therapy

This thesis provides new insights in diagnostics and therapy of cutaneous head and neck melanoma. The concept of cutaneous melanoma treatment has changed significantly over the past two decades. The first part of this thesis, entitled ‘Diagnostics’, focuses on the evaluation of the new 8^th AJCC cancer staging manual, including the application of new technologies in sentinel lymph node biopsy and selection of prognostic factors for individualized treatment.
Improved knowledge of molecular biology, especially in the field of cancer immunology, has contributed to the innovative designs of curative immunotherapy trials in stage III cutaneous melanoma patients. This potentially curative treatment option positions the role of therapeutic regional dissections from a different perspective, marked by a shift from extensive dissections to more limited salvage operations for removal of residual lymph node metastases. The second part of this thesis, entitled ‘Therapy’, focuses on the value of standard curative surgical protocols for stage III head and neck cutaneous melanoma and on the role of new oncolytic immunotherapy in stage III-IV cutaneous melanoma. This thesis seeks to increase awareness of the effects of diagnostics and limited surgery in the pre-immunological era.