Social determinants of health (SDoH) are key drivers of disparities in head and neck cancer (HNC) outcomes, contributing to late-stage presentation and increased mortality. Current research primarily focuses on individual and healthcare system factors, with insufficient representation of broader societal influences. To address this gap, we developed a uniform data set (UDS) integrating multilevel SDoH measures with oncologic healthcare delivery metrics. In phase I, an expert advisory board used an iterative process to establish consensus on key data elements for the UDS. In phase 2, a multi-institutional pilot study was launched at six academic centers to evaluate its feasibility. We present the outcomes of the expert panel and the implementation of the pilot study. Our co-developed data collection instrument supports the establishment of a UDS for identifying drivers of disparities in HNC. While multi-institutional pilots remain challenging, cultivating networks of institutions and institutional review boards (IRBs) facilitates collaborative evaluation of healthcare disparities.

Sentinel lymph node biopsy remains the most sensitive and specific staging modality for cutaneous head and neck melanoma. It is a minimally invasive procedure used to identify occult, micrometastatic disease which upstages the patient. This staging dictates all further treatment recommendations to include surgical management of nodal basins and adjuvant therapy. Primary tumor thickness is the single most important factor dictating risk for a positive sentinel node. All patients with localized disease with a depth of invasion of 1 mm or greater should be considered for the procedure. The goal of this chapter is to highlight the melanoma sentinel lymph node procedure with emphasis on targeted patients, surgical technique and associated treatment options. In addition, recent changes in the management of positive sentinel nodes will be highlighted along with the evidence based clinical trials driving these treatment decisions.

BACKGROUND:Immunosuppression is a major, known risk factor for cutaneous squamous cell carcinoma (CSCC). Immunosuppressed patients with CSCC are at significantly increased risk of recurrence and death compared to their non-immunosuppressed counterparts. To date, this high-risk population has been excluded from most clinical trials. METHODS:The National Cancer Institute Head and Neck Cancer Steering Committee (NCI-HNSC) commissioned a Clinical Trials Planning Meeting (CTPM) specifically for immunosuppressed patients with high-risk/advanced CSCC. The CTPM was designed to bring together key scientific and pharmaceutical stakeholders, as well as multi-disciplinary physician sub-specialists who manage these high-risk, complex patients with the goal of developing clinical trial concepts that could be readily conducted through the NCI Clinical Trial Network (NCTN) groups. RESULTS:With extensive virtual pre-planning and a 2-day in-person summary meeting, the CTPM was structured as two multi-disciplinary breakout groups focused on immunosuppressed populations with either: 1) high risk resectable CSCC; or 2) advanced/metastatic CSCC. Five clinical trial concepts were designed specifically for immunosuppressed patients and suitable to conduct via NCTN groups. CONCLUSIONS:A CTPM was successfully conducted for immunosuppressed patients with CSCC, a historically underserved population with poor clinical outcomes.

Peer review is an essential cornerstone of scientific advancement. This process involves understanding study design, data analytics, and interpretation of the evidence. For clinicians who are performing their initial peer reviews, and even for seasoned reviewers who assess complex manuscripts, it can be helpful to have a standard approach. We therefore provide a conceptual framework for peer review which builds upon experiences that are already familiar to trainees and practicing clinicians, by drawing parallels between patient encounters and peer review. This framework has been used in successive years as a didactic tool for our trainees who are being mentored toward excellence in peer review.

Neoadjuvant immunotherapy is changing the treatment paradigm for patients with advanced cutaneous melanoma. This systemic approach leverages the presence of tumor antigens to generate a robust and durable antitumor immune response compared to traditional adjuvant therapy. The comprehensive review highlights contemporary clinical trials shaping the landscape of melanoma treatment algorithms. Single-modality agents and combination regimens are outlined along with response-adapted strategies, which aim to balance efficacy and toxicity. These novel neoadjuvant immunotherapy strategies promise to further refine treatment in a personalized manner, ideally offering patients the opportunity for greater response, reduced treatment toxicity, and improved long-term survival.

Objective Solid organ transplant (SOT) recipients carry a higher incidence of cutaneous squamous cell carcinoma (cSCC) with more aggressive features and worse outcomes compared to immunocompetent (IC) patients. The National Comprehensive Cancer Network advocates peripheral and deep en-face margin assessment such as Mohs micrographic surgery (MMS) for very-high-risk cSCC. We aim to assess the efficacy of MMS in the treatment of SOT immunosuppressed head and neck (HN) cSCC patients. Study Design Cohort study with planned chart review enrolling HN cSCC patients (2004-2017). Setting Patients were enrolled from a tertiary care medical center registry. Methods Patients with cSCC were categorized on the independent variable of immune status. The incidence of MMS was compared between IC and SOT patients. Subgroup analysis of a matched cohort of patients treated with only MMS was performed for patient demographics, tumor characteristics, recurrence rates, and survival. Results A total Of 178 HN cSCC patients met the criteria. SOT patients were more likely to be treated with MMS, P < .001. In the subgroup analysis, 34 matched patients were treated with MMS alone. There was homogeneity between groups regarding patient demographics and tumor characteristics. One patient developed local recurrence in the SOT cohort (P = .310). Compared to IC cSCC patients, SOT patients treated with MMS did not experience worse disease-free or overall survival (OS) (P = .540). Conclusion This study suggests that narrow-margin MMS is an appropriate treatment option for SOT cSCC patients. SOT patients were more likely to be treated with MMS and did not compromise local recurrence, disease-free, or OS.

Background: Nonsurgical management of congenital ear anomalies using molding devices shows efficacy but lacks standardization of treatment protocols and outcome measures. Learning Objective: To compare ear molding techniques and identify factors related to treatment outcomes. Design Type: Systematic review of the literature (1990-2021). Methods: Studies reporting molding for congenital ear anomalies were assessed. PRISMA guidelines were used. Data extracted included: age at treatment initiation, treatment duration, correction rates, and complications. Data analysis included descriptive statistics and outcomes were compared using the Student t-test. Results: In total, 37 studies with 3,341 patients (mean patients per study, 95; range, 5-488) were included. Infants in whom treatment was initiated at 4.8 weeks (median, 3.7; range, 0.9-8.8 weeks) were treated for 5.1 weeks (median 4.7, range 2.6-7.6 weeks) with 11.0 months follow-up (median 11.4, range 1.4-21.0 months). Individualized devices (physician-customized) were used more (62.2% of studies) than commercial devices. No difference in correction (p = 0.44) or complication rates (p = 0.19) was identified between devices. Totally, 70.3% of studies reported complications and 40.5% of studies included long-term follow-up data. Conclusions: The available evidence supports initiating ear molding in the first weeks of life to be most effective, yet outcome data should be standardized in future studies to improve evidence quality.

Basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC), and Merkel cell carcinoma (MCC) comprise the majority of nonmelanoma skin cancers. Advances have been made in treatment. Sentinel node biopsy should be considered for locally advanced, clinically node-negative cSCCs and MCCs. BCC patients failing traditional surgery and/or radiation are candidates for systemic hedgehog inhibitor therapy. Immune checkpoint inhibitor treatment is available for patients who failed traditional treatment with surgery and/or radiation or who are not candidates for these modalities. Specifically, cemiplimab is approved for advanced BCC; cemiplimab and pembrolizumab for advanced cSCC; and avelumab, pembrolizumab, and retifanlimab-dlwr for recurrent/metastatic MCC.

Otolaryngology–Head and Neck SurgeryVolume 170, Issue 6 p. 1483-1483 Editorial Our Otolaryngology Future With Artificial Intelligence Cecelia E. Schmalbach MD, MSc, Corresponding Author Cecelia E. Schmalbach MD, MSc Editor in Chief [email protected] Department of Otolaryngology-HNS, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA Corresponding Author: Cecelia E. Schmalbach, MD, MSc, Department of Otolaryngology-HNS, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA. Email: [email protected]Search for more papers by this author Cecelia E. Schmalbach MD, MSc, Corresponding Author Cecelia E. Schmalbach MD, MSc Editor in Chief [email protected] Department of Otolaryngology-HNS, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA Corresponding Author: Cecelia E. Schmalbach, MD, MSc, Department of Otolaryngology-HNS, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA. Email: [email protected]Search for more papers by this author First published: 30 May 2024 https://doi.org/10.1002/ohn.802Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume170, Issue6Special Issue: Science in the Age of Artificial IntelligenceJune 2024Pages 1483-1483 RelatedInformation

BACKGROUND:A position statement put forth by the American Head and Neck Society (AHNS) was constructed to provide evidence-based treatment recommendations for PD-1 inhibitor use in advanced cutaneous squamous cell carcinoma (cSCC). Secondarily, we sought to identify knowledge gaps warranting further investigation.METHODS:A literature search utilizing key terms: cutaneous squamous cell carcinoma, cutaneous cancer, checkpoint inhibitors, systemic therapy, Program Cell Death, PD-1 (PubMed, Cochrane, and Google Scholar) was carried out to generate evidence-based statements. The statements were distributed among the AHNS membership. Delphi methodology was applied to identify statements achieving 70% or greater consensus among the leadership team.RESULTS:Twenty-six position statements achieved consensus. Knowledge gaps for future research included: impact of immunosuppression on cSCC staging and associated treatment; role of PD-1 inhibitors in immunosuppressed patients.CONCLUSION:This comprehensive position statement put forth by the AHNS represents majority consensus by practicing head and neck surgeons throughout the country.

PURPOSE OF REVIEW:Surgery remains the mainstay of treatment for non-melanoma skin cancer (NMSC). Immunotherapy (IO) has emerged as an alternative option. This review provides a contemporary summary of how to incorporate IO into the management of advanced NMSC. Evidence-based outcomes and recent clinical trials are provided with emphasis on the three most common NMSC diagnoses: cutaneous squamous cell carcinoma (cSCC), basal cell carcinoma (BCC), and merkel cell carcinoma (MCC).RECENT FINDINGS:Surgical resection while preserving form and function remains the standard of care for the majority of NMSCs. In recalcitrant cases failing traditional surgery and/or primary radiation, patient ineligible for such treatments, or unresectable disease, IO has emerged as a promising alternative. In the majority of cases, it is a supplanting primary chemotherapy. Surgery remains the standard of care for NMSC. Immunotherapy has emerged as an alternative option for non-surgical candidates and as a neoadjuvant means to minimize morbidity.

Supplemental Figure S1 Pharmacokinetics of cetuximab-IRDye800. Supplemental Figure S2 Fluorescent imaging of positive margin using intraoperative instrument. Supplementary Figure S3 Opportunity for tissue saving procedures.

e24103 Background: Malnutrition and poor dietary habits are associated with worse outcomes and decreased quality of life (QOL) in patients with HNC. Given the lack of standardized assessment of diet in survivors of HNC but the concern for long term malnutrition risk, we piloted a recently developed computerized FFQ that provides individualized dietary feedback (Vioscreen) in survivors of HNC. We sought to assess its feasibility and acceptability and explore associations between diet quality, QOL, and patient/treatment characteristics. Methods: We recruited HNC patients who had completed cancer treatment (radiation alone, chemoradiation, surgery/radiation, surgery/chemoradiation) at least 6 months prior to study enrollment who did not have a feeding tube. Dietary assessment was conducted using Vioscreen. Dietary quality was defined by Healthy Eating Index (HEI) and calculated by the participant’s response. All patients received an individualized feedback report. Patients also completed the EORTC QLQ-C30 and H&N35. At 6 weeks, we administered an acceptability questionnaire on usability of Vioscreen and perceived dietary changes. Results: 50 patients consented to participate. Of these, 34 (68%) completed all initial questionnaires. Of the 34 participants, majority were white/non-Hispanic, male, with oropharynx primaries, and median time from treatment was 68.4 months. Of the 27 who completed acceptability, 15 (56%) considered the Vioscreen tool to be useful, 9 (36%) reported they made changes to diet, and 16 (59%) would recommend to others. Mean HEI score was 63.2 (SD 11.3). There were no statistically significant differences in HEI scores between participants who were male vs female or based on time from treatment. There was a numeric difference in HEI scores for those with oral cavity/larynx cancers vs. oropharynx (58.3 vs 65.6; p = 0.06), and those with bimodality vs. trimodality treatment (66.1 vs 57.3; p = 0.07), but this did not reach statistical significance. There was a significant positive correlation with higher HEI scores and less trismus as reported on the EORTC H&N35 questionnaire (r = .49, p < .01). Additionally, the participants who found the Vioscreen useful were less likely to report swallowing difficulties on the EORTC H&N35 (p = 0.046) and less likely to have had surgery as part of treatment (p = 0.046). Conclusions: For survivors of HNC, Vioscreen was useful to > 50% of participants. Diet quality and swallowing issues were worse in patients receiving trimodality treatment; those reporting more swallowing complaints also reported the Vioscreen tool was less useful. Thus, using Vioscreen as a stand-alone intervention may be insufficient for these populations. Future studies will couple the Vioscreen FFQ with a nutrition counseling intervention.

Psychological safety is the concept that an individual feels comfortable asking questions, voicing ideas or concerns, and taking risks without undue fear of humiliation or criticism. In health care, psychological safety is associated with improved patient safety outcomes, increased clinician engagement, and greater creativity. A culture of psychological safety is imperative for physician well-being and satisfaction, which in turn directly affect delivery of care. For health care professionals, psychological safety creates an environment conducive to trust and openness, enabling the team to focus on high-quality care. In contrast, unprofessional behavior reduces psychological safety and threatens the culture of the organization. This patient safety/quality improvement primer considers the barriers and facilitators to psychological safety in health care; outlines principles for creating a psychologically safe environment; and presents strategies for managing conflict, microaggressions, and lapses in professionalism. Individuals and organizations share the responsibility of promoting psychological safety through proactive policies, conflict management, interventions for microaggressions, and cultivation of emotional intelligence.

Voice restoration following laryngectomy has a significant influence on quality of life (QOL). Three main techniques exist to provide voice: esophageal speech (ES), artificial larynx (electrolarynx [EL]), and tracheoesophageal puncture (TEP). Although the EL was historically the most used technique, TEP has quickly become the gold standard. ES remains the least frequently used technique in developed countries. Technique selection must be made on an individual basis, considering the patient's cancer history and comorbidities. Ultimately, the choice in voice-restoration technique requires joint decision making with the surgeon, speech pathologist , and patient.

Simulation training has taken a prominent role in otolaryngology-head and neck surgery (OTO-HNS) as a means to ensure patient safety and quality improvement (PS/QI). While it is often equated to resident training, this tool has value in lifelong learning and extends beyond the individual otolaryngologists to include simulation-based learning for teams and health systems processes. Part III of this PS/QI primer provides an overview of simulation in medicine and specific applications within the field of OTO-HNS. The impact of simulation on PS/QI will be presented in an evidence-based fashion to include the use of run and statistical process control charts to assess the impact of simulation-guided initiatives. Last, steps in developing a simulation program focused on PS/QI will be outlined with future opportunities for OTO-HNS simulation.

Fractures of the zygomaticomaxillary complex and zygomatic arch are common athletic injuries. Fracture displacement can lead to midfacial retrusion and widening, causing noticeable deformity. Associated signs and symptoms include hypoesthesia of the infraorbital nerve distribution, trismus, and subjective malocclusion. Operative treatment is indicated in cases of significant displacement or functional disturbance. The approach and details of osteosynthesis are catered to the specific characteristics of the fracture. Technology, such as virtual surgical planning, intraoperative navigation, and intraoperative imaging, has the potential to improve accuracy of treating challenging fractures.