Aggressive Nonmelanomatous Skin Cancer of the Head and Neck

Introduction/Background Although the overwhelming majority of nonmelanomatous and non-Merkel cell skin cancer (NMSC) of the head and neck, specifically basal cell carcinoma (BCC) and squamous cell carcinomas (SCC), is easily cured with surgical removal, superficial radiation therapy (RT), and/or ablation alone, there is a subset of these tumors— either due to neglect or unfavorable biological features—that exhibit aggressive clinical behavior. This subset also includes patients who present with locoregionally advanced disease and experience substantial rates of cancer recurrence and cancer-related morbidity and mortality. The incidence of these cancers is rising, most prominently among the immunosuppressed population. These patients commonly require multimodality therapy and frequently present therapeutic challenges as there is a paucity of high-quality clinical trials to guide clinical decision making. RT plays an important role in the management of these tumors, both in the postoperative and definitive settings.