Recent updates in the management of cutaneous melanoma of the head and neck

To summarize recent developments in staging and treatment strategies for cutaneous melanoma of the head and neck, emphasizing the impact of sentinel lymph node biopsy (SLNB) and immunotherapy on patient outcomes. A narrative review of pivotal clinical trials and guideline updates was conducted, focusing on surgical, staging, and systemic management of head and neck cutaneous melanoma. Key trials informing current National Comprehensive Cancer Network (NCCN) and American Joint Committee on Cancer (AJCC) recommendations were reviewed. The AJCC 8th edition refined staging parameters, emphasizing Breslow thickness, ulceration, and clinically occult nodal disease identified by SLNB. Landmark trials, including MSLT-I, DeCOG-SLT, and MSLT-II, demonstrated that SLNB provides essential prognostic information without a survival benefit from completion lymph node dissection (CLND). Recent data from neoadjuvant immunotherapy trials including SWOG S1801, OpACIN, and PRADO support the use of checkpoint inhibitors such as pembrolizumab and nivolumab in resectable high-risk disease. Pathologic response-based de-escalation of surgery and adjuvant therapy has emerged as a safe and effective approach, reducing morbidity while maintaining oncologic control. Advances in melanoma staging and immunotherapy have transformed the management of head and neck disease. SLNB remains a cornerstone for accurate prognostication, while neoadjuvant and adjuvant immunotherapy strategies allow individualized, less invasive, and more effective treatment. Continued integration of molecular and pathologic response data promises to further refine personalized care for patients with head and neck melanoma.