Head and neck skin cancer The clinical applications of reflectance confocal microscopy

Skin cancer has become the most common malignancy among fair-skinned populations worldwide, with the incidence rates continuing to rise rapidly. The head and neck region is particularly susceptible to developing skin cancer, as it is exposed to all forms of UV radiation. The primary challenges in treating skin cancer in this region are the complexity of anatomy and cosmesis. Surgery is often the preferred treatment, but it may not always be feasible owing to the potential functional or cosmetic consequences. Multidisciplinary decision making is often necessary to provide the best possible outcomes for patients with (advanced) skin cancer of the head and neck.
The research presented in this thesis has a specific emphasis on lentigo maligna (melanoma), a subtype of melanoma that typically presents in this anatomical region and is associated with older age at presentation and high local recurrence rates, and basal cell carcinoma, the most common form of skin cancer, also with a predilection for the head and neck. It reviews the effects of different surgical techniques used to manage lentigo maligna (melanoma) on local recurrence and survival outcomes. Second, it evaluates the reliability of in vivo handheld reflectance confocal microscopy in the presurgical mapping of lentigo maligna (melanoma), the detection of subclinical invasive melanoma, and its effect on management decisions. Third, it examines the value of sentinel lymph node biopsy for patients with lentigo maligna melanoma using the nationwide network and registry of histo- and cytopathology in the Netherlands (PALGA). Finally, the current management of basal cell carcinoma is highly dependent on diagnostic biopsies. The concluding part of this thesis evaluates the accuracy of basal cell carcinoma diagnosis and subtyping using handheld reflectance confocal microscopy.
In summary, this thesis explored the different diagnostic and therapeutic challenges associated with lentigo maligna (melanoma) and basal cell carcinoma and the role of handheld reflectance confocal microscopy in addressing these issues.