A diverse group of conditions may affect the major and minor salivary glands. Non-neoplastic disorders usually manifest as diffuse unilateral or bilateral glandular enlargement. Etiologies of diffuse salivary gland enlargement include acute and chronic inflammatory and non-inflammatory disorders. Often a thorough history and physical examination with directed diagnostic investigations will yield a diagnosis. Treatment is dependent on the diagnosis and is often guided by patient complaints.

Mucosal Melanoma is a rare cancer that is most often found in the head and neck. Patients generally present at an advanced stage since lesions produce non-specific symptoms, and the cancer biology is aggressive. Treatment goals include complete resection with postop radiation therapy. Unlike cutaneous melanoma, biologic treatments based on genetic analyses and sentinel lymph node biopsies are not mainstays of treatment. Prognosis remains poor and otolaryngologists must maintain a high index of suspicion to accurately diagnose this disease. 

Nonmelanoma skin cancers (NMSC) are the most common types of malignancy in the world and the incidence of this disease in the US is increasing due to high rates of sun exposure, the aging of our population and a greater number of individuals immunosuppressed for organ transplantation. Basal cell carcinomas make up about 80% of NMSCs however results in the fewest number of cancer related deaths. These tumors can be locally invasive, however very rarely metastasize.

In general, melanoma is treated by primary surgical excision. The melanoma intergroup study did not demonstrate a benefit of elective node dissection. Adjuvant IFN alpha-2b has a role in high-risk melanoma. Although sentinel node biopsy is widely used, controversy exists on its effectiveness in head and neck melanoma. The management of patients with metastatic melanoma has changed significantly with the evolving use of targeted and immunotherapy.

Elderly patients account for a growing proportion of those with head and neck cancer. Moreover, this proportion is expected to grow as the U.S. population ages. Surgical and radiation therapy have been demonstrated to maintain their oncologic efficacy in elderly patients. However, elderly patients are more likely to suffer from co-morbid disease that increase their chances of perioperative medical complications and can result in unplanned treatment breaks.

Immunocompromised patients may present with diverse pathologies of the head and neck that range from benign to life-threatening. A complete evaluation including a detailed history and physical examination is important in arriving at the correct diagnosis. Malignancies and atypical infections are more common in immunosuppressed individuals, so a broad differential should be maintained during an evaluation. These patients are managed in a multidisciplinary fashion and significant weight should be placed on correcting the underlying etiology of the immune dysfunction.

Pain is a common symptom experienced by survivors of head and neck malignancies. Pain may be detrimental to a patient’s survivorship experience through limitations in activity, motivation, ability to speak or swallow, and may contribute to poor quality of life. Patients with head and neck cancer should be screened for pain at each clinical encounter. Pain related symptomatology should prompt a comprehensive evaluation including assessment of pain and related symptoms, its implications on the patient’s quality of life, and the underlying etiology.

End of life issues surrounding head and neck cancer can be complex and overwhelming for both patient and physician; it is incumbent upon the physician to be aware of the impact of the diagnosis on multiple aspects of the patient’s life. Developing skills in having difficult conversations and engaging in shared decision making are paramount, as well as being aware of and anticipating issues related to physical and psychosocial functioning and offering varied options for palliation. Multidisciplinary care, including integrative and complementary medicine, should be the goal. 

The nutritional status of head and neck cancer patients is critically important to consider. Exciting advances have been made in the understanding of the mechanism of cancer anorexia-cachexia syndrome and how to best treat it. Patients with head and neck cancer have many possible reasons for malnutrition including the tumor burden, site of the tumor, pain, inability to take oral nutrition, xerostomia, and the effects of treatment (surgery, radiation and chemo- therapy). They are at high risk for malnutrition and studies have shown that they have better outcomes and quality of life if nutrit

1. Define the TNM staging for each of the subsets of head and neck cancer as defined by the AJCC.
2. Outline the major risk factors for the development of squamous cell carcinoma of the head and neck and the current trends in epidemiology.
3. Describe the multiple-hit theory of tumorigenesis and its implications for diagnosis and treatment.
4. Outline with the current mechanisms for targeted therapies for use in the treatment of head and neck squamous cell carcinoma.