Aggressive Cutaneous Carcinoma with Osteocartilaginous Invasion and Upper Airway Compromise: Multidisciplinary Management, Three-Dimensional Reconstruction, and Personalized Medicine – A Comprehensive Review

Abstract

Cutaneous carcinoma of the head and neck, predominantly cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma (BCC), represents a highly prevalent malignancy. In its aggressive variants, it can infiltrate osteocartilaginous structures and compromise the upper airway, leading to substantially elevated morbidity and mortality. Bone and cartilage invasion is recognized as an adverse prognostic factor, with local recurrence and distant metastasis rates exceeding 30% in advanced stages. Effective management of these complex tumors demands a multidisciplinary paradigm that seamlessly integrates surgical oncology, radiotherapy, immunotherapy, and state-of-the-art three-dimensional reconstructive techniques. This comprehensive literature review aims to synthesize the current evidence on aggressive cutaneous carcinoma with osteocartilaginous invasion and upper airway involvement, focusing on multidisciplinary management strategies, three-dimensional reconstruction modalities, and the evolving landscape of personalized medicine. A systematic literature search was performed in PubMed, Scopus, and Web of Science, covering publications up to May 2026, in accordance with PRISMA guidelines. Eligible studies included original research, systematic reviews, meta-analyses, and clinical practice guidelines addressing head and neck cutaneous tumors with deep structural invasion, reconstructive surgical approaches, and biomarker-driven personalized therapies. Surgical resection with negative margins remains the gold-standard curative intervention. However, osteocartilaginous and perineural invasion frequently necessitates wide, extensive resections that create significant composite defects, subsequently requiring complex functional and aesthetic reconstruction. This is increasingly achieved through microvascular free tissue transfer and patient-specific implants guided by preoperative three-dimensional virtual surgical planning. In the systemic therapy arena, immune checkpoint inhibitors (anti-PD-1) have demonstrated robust efficacy in unresectable, locally advanced, or metastatic disease. Concurrently, precision oncology leveraging molecular biomarkers and next-generation sequencing is poised to refine patient stratification and tailor adjuvant treatments, although these approaches remain under active investigation. Aggressive cutaneous carcinoma with osteocartilaginous invasion and upper airway compromise remains a formidable oncological and reconstructive challenge requiring integrated multidisciplinary management. The incorporation of three-dimensional planning and the rapid advancements in immunotherapy and personalized molecular medicine are significantly improving prognostic outcomes, yet further prospective studies are critically needed to establish standardized, evidence-based therapeutic algorithms.