The majority of skin cancers of the head and neck are represented by basal cell carcinoma (BCC) and cutaneous squamosal cell carcinoma (CSCC), both non-melanoma skin cancers. Identified in the early stages, the cure rate is considered high. Sun protection and early identification of suspicious lesions are the optimal strategies for these cancers to be associated with higher response rates and favorable cosmetic results. Even if the incidence is lower, 10% to 25% of melanomas could also be identified in the head and neck region. For advanced stages or for cases ineligible for optimal surgical treatment, the multimodal approach including adjuvant radiotherapy, chemotherapy, biological therapy or immunotherapy must be decided in a multidisciplinary team. We set out to retrospectively evaluate the data of patients with skin tumors in the head and neck region included in the cancer registry of Dolj county between January 2000 and December 2019. Seventy-three patients were subsequently identified who met the inclusion criteria. The median age of the patients was 73 years (46 to 98). Forty-six cases of these were BCC, 15 CSCC cases, 1 adenoid cystic carcinoma case, 1 malignant melanoma case and one case without histopathological confirmation. The ratio between BCC and CSCC in our study is 3:1, in concordance with the ratio identified in the literature. The vast majority of cases come from the urban environment, surgery being the main treatment, especially for the early stages. Adjuvant radiotherapy was administered both in cases of BCC and epidermoid carcinoma. Adjuvant polychemotherapy, interferon therapy and re-irradiation have also been used. Considering the main risk factor, exposure to the sun, it is possible that the predominance of cases from cities is caused by underreporting of these types of cancer in rural communities where the main occupation is agriculture, associated with sun exposure, but also by a lower addressability or non-compliance with the inclusion in the oncological monitoring programs. The current existence of some modern oncological therapies, including immunotherapy for CSS and malignant melanoma, justifies a better monitoring and inclusion of these cases in multidisciplinary evaluation. Superficial radiotherapy, which has now become less accessible in our country, due to the implementation of radiological safety rules and the conversion of equipment from the former Soviet Union cobalt and superficial X-ray radiotherapy device to modern liniac accelerators focused on modern techniques radiotherapy is necessary to reduce the risk of recurrence in the case of resection with inadequate margins of non-melanoma skin tumors.

Concurrent chemo-radiotherapy with Cisplatin is the standard treatment for locally advanced non-metastatic squamous cell carcinoma of the head and neck (HNSCC), but induction chemotherapy (IC) followed by chemo-irradiation, even controversial is a widely accepted option, especially in high- risk cases. A regimen including triple association (platinum-taxanes-fluorouracil) is generally considered superior in efficacy, but may be associated with severe toxicity. In the case of recurrence, the options are limited and the prognosis is generally unfavorable. Chemotherapy alone or in combination with an anti-EGFR monoclonal antibody (Cetuximab), immunotherapy or re-irradiation for selected cases are feasible options in loco-regional or metastatic repalapse. We present a case of nasopharyngeal cancer (NPC), with negative prognostic and predictive factors multimodally treated with an intensive chemotherapy regimen associating Cetuximab with a median survival higher than the median value reported in most studies. Replacing 5-Floururacil with Capecitabine and Cisplatin with Carboplatin may be an option to increase treatment tolerance and should be evaluated in randomized trials. The use of induction chemotherapy as a “new standard” before radio-chemotherapy for cases with negative prognostic factors should also be the subject of future studies. Re-challenge with platinum is also an option that needs to be re-evaluated.