About

Marcus M. Monroe, MD, is an associate professor in the Department of Otolaryngology—Head and Neck Surgery at the University of Utah School of Medicine. He is a surgeon and investigator with the Huntsman Cancer Institute, specializing in the complex multidisciplinary care of patients with head and neck cancer. Dr. Monroe serves as the Division Chief of Head and Neck Surgical Oncology within the Department of Otolaryngology and leads the Head and Neck Disease Center and the Head and Neck Clinical Trials Program at the Huntsman Cancer Institute. His clinical practice involves treating patients with advanced head and neck skin cancers, thyroid and parathyroid tumors, salivary gland tumors, and cancers of the upper aerodigestive tract, including the oral cavity, pharynx, larynx, and sinuses. He believes that the best care results from a team of specialists working together to create tailored treatment plans, collaborating closely with medical and radiation oncologists, dermatologists, endocrinologists, pathologists, and radiologists to determine the most effective treatment for each patient.

Research topics

• Internal medicine
• Medicine
• Oncology
• Surgery
• Genetics
• Biology
• Pathology
• Cancer research
• Immunology

Selected publications

• Facial Nerve Grafting after Malignant Nerve Sacrifice: Functional Outcomes With and Without Adjuvant Radiation

  Facial Plastic Surgery & Aesthetic Medicine · 2026-04-03

  article
  PublisherDOI

• Association Between Postoperative NSAID Use and Bleeding Following Transoral Robotic Surgery

  Otolaryngology · 2026-04-30

  articleOpen access

  OBJECTIVE: To evaluate the safety and outcomes of NSAID use following transoral robotic surgery (TORS). STUDY DESIGN: Retrospective cohort study using propensity score matching. SETTING: Multi-institutional database (TriNetX). METHODS: Patients undergoing TORS were identified using ICD-10 codes. Two propensity-matched cohorts were compared: (1) patients receiving NSAIDs (ketorolac, celecoxib, ibuprofen) within 14 days postsurgery (n = 3639) versus controls (n = 3639) and (2) patients receiving ketorolac day-of-surgery (n = 1901) versus controls (n = 1901). Primary outcome was postoperative hemorrhage. Secondary outcomes included critical care admission, emergency department visit, and feeding device placement within 14 days. RESULTS: Postoperative bleeding rates were similar between NSAID and control groups (P = .150). Patients treated with NSAIDs had lower rates of critical care admission (P < .001) and feeding tube placement (P < .001). Emergency department visits showed no significant difference (P = .813). Day-of-surgery ketorolac versus control showed no increased bleeding (P = .460). Ketorolac patients demonstrated significantly lower rates of critical care admission (P < .001) and feeding tube placement (P < .001), with no increase in emergency department visits (P = .312). CONCLUSION: NSAID administration following TORS was not associated with increased postoperative hemorrhage. NSAID use was associated with reduced critical care utilization and feeding tube requirements. These findings support the safety of NSAIDs in multimodal analgesia protocols for TORS patients.

  PublisherDOI

• Long-term follow-up of patterns of melanoma early and late recurrence after adjuvant anti-PD1 therapy.

  Journal of Clinical Oncology · 2025-05-28

  article

  e21527 Background: Despite the promise of immune checkpoint inhibitors (ICI), 25-30% of stage III/IV patients (pts) with (w) resected melanoma develop relapsed disease by 12 months (mon) after adjuvant (adj) anti-PD1 (aPD1). Understanding the recurrence patterns and resistant mechanisms is critical to develop strategies for better outcomes. Methods: Through an approved protocol by Institutional IRB, 172 ICI naive pts w resected high-risk melanoma who received adj aPD1 were consented and followed prospectively. Clinical outcomes were assessed by ORR per RECIST 1.1, PFS, OS and time to next treatment (TTNT). Results: With median follow up of 36 mon (5-98), melanoma recurred in 90 (52%) of 172 pts treated w adj aPD1, including 59 (66%) w early PD (PD while on or w/in 3 mon of last adj aPD1) and 31 (34%) w late PD (PD &gt; 3 mon from last adj anti-PD1). 57 (67%) males, median age 56 (25-84) at C1D1, 3/82/5 at stage II/III/IV. Subtypes included 43 (48%) superficial spreading and 24 (27%) nodular. 44 (49%) had locoregional PD while 46 (51%) had distant PD. 6 pts died at relapse or shortly after. Of the 24 pts w resectable recurrence, the subsequent PD rate after surgery (sx) was 5/14 (36%) if followed by adj aPD1 +/- others, 4/7 (57%) by adj ipi/nivo, and 3/3 (100%) by adj targeted therapy which is associated w much shorter median TTNT. Of the 60 pts who received systemic therapy only after recurrence, ORR to rechallenge w aPD1, anti-CTLA4 + aPD1, targeted therapy +/- aPD1, TVEC/other injectables +/- aPD1, Opdualag and chemo were 57%, 26%, 62%, 30%, 0% and 0%; including those w early PD, ORR of 0% (0/2), 25% (5/20), 63% (5/8), 22% (2/9), 0% (0/1) and NA; and w late PD, ORR of 80% (4/5), 29% (2/7), 60% (3/5), 100% (1/1), 0% (0/1) and 100% (1/1). Median TMB tends to be higher in pts who benefited from systemic ICI, except pts who benefited from TVEC had much lower median TMB (1 vs 17). Conclusions: With the known longest follow up, half of pts w high risk resected melanoma developed PD after adj aPD1, and 2/3rds of those are early PD. Half of resectable relapse can be managed by sx followed by adj ICI w/o further PD. Most of the late PD rechallenged w aPD1 can still respond. Pts w lower TMB might benefit more from TVEC approach. Sx + adj aPD1 +/- others (no ipi) N=14 Sx + adj ipi/nivo N=7 Sx + adj targeted therapy N=3 Rechallenge w aPD1 N=7 Anti-CTLA4 + aPD1 N=27 Targeted therapy +/- aPD1 N=13 TVEC +/- `aPD1 N=10 Opdualag N=2 Chemo N=1 CR/PR or NED 9 3 0 4 7 8 3 0 1 SD 0 0 0 0 1 1 0 0 0 PD 5 4 3 3 19 4 7 2 0 ORR or non-relapse rate 64% 43% 0% 57% 26% 62% 30% 0% 0% Median PFS (m) 7 (2-70) 8 (2-44) 6 (1-16) 5 (1-32) 3 (1-59) 4 (1-17) 3 (0.7-12) 4 (4-5) 1 Median OS (m) 22 (3-69) 15 (8-50) 21 (8-39) 20 (2-44) 10 (1-61) 16 (3-67) 28 (6-94) 12 (6-18) 3 Median TTNT (m) 11 (3-70) 11 (3-44) 6 (1-18) 10 (3-32) 9 (1-59) 7 (1-26) 5 (0.7-13) 6 (5-6) 10 Median TMB CR/PR/NED vs PD (mut/mb) 12 / 7 (3-25) 5 /3 (3-7) NA / 2 80 / NA 13 / 5 (0.2-13) NA / 8 (0.4-20)

  PublisherDOI

• Outcomes of Salvage Surgery for Recurrent Cutaneous Squamous Cell Carcinoma of the Head and Neck Following Definitive Surgery and Radiation Therapy

  Annals of Otology Rhinology & Laryngology · 2025-05-03 · 2 citations

  articleSenior author

  OBJECTIVE: To describe outcomes of patients with a history of cutaneous squamous cell carcinoma (cSCC) of the head and neck previously treated with definitive surgery and radiation therapy (RT), who undergo salvage surgery for disease recurrence. There is minimal data available on this cohort of patients. METHODS: This was a retrospective case series. Patients evaluated for advanced cSCC of the head and neck between 2003 and 2022 were reviewed. Those with a history of surgery and adjuvant RT undergoing salvage surgery for recurrence were included in the main cohort. Comparisons were made to patients undergoing primary/initial treatment, and to those undergoing salvage surgery for recurrence but without a history of adjuvant RT. RESULTS: Of the 579 patients reviewed, 49 met inclusion criteria for the main cohort. Average length of follow up was 22 months. A total of 19 patients (38.8%) experienced recurrence, all within 14 months of salvage surgery. Among patents staged BWH T2b or T3, there was a 50% recurrence rate. Average overall survival following surgery was 35.6 months (95% CI = 24.7-46.4). CONCLUSION: Patients in this cohort have a high rate of recurrence and an overall survival of approximately 3 years.

  PublisherDOI

• Phase 3 randomized trial (KEYNOTE-630) of adjuvant pembrolizumab (pembro) versus placebo (pbo) for high-risk locally advanced cutaneous squamous cell carcinoma (LA cSCC) following surgery and radiation (RT).

  Journal of Clinical Oncology · 2025-05-28 · 11 citations

  article

  6000 Background: Patients with high-risk LA cSCC are standardly treated with surgical resection followed by postoperative RT. Up to 30% of pts experience recurrence and/or metastasis. PD-1 inhibitors including pembro are approved in the US for recurrent/metastatic or LA cSCC not curable by surgery or radiation. We present results from the randomized, double-blind, phase 3 KEYNOTE-630 trial (NCT03833167) that evaluated the efficacy and safety of the addition of adjuvant pembro for participants (pts) with high-risk LA cSCC. Methods: Adults with histologically confirmed LA cSCC with ≥1 protocol-defined high-risk feature who underwent complete macroscropic resection and completed adjuvant RT ≥4 and ≤16 weeks from randomization were randomly assigned 1:1 to receive pembro 400 mg or placebo (pbo) IV Q6W for ≤9 cycles. The primary end point was recurrence-free survival (RFS), defined as the time from randomization to the first event of local or regional recurrence of index lesion, distant metastasis, or death due to any cause. Secondary end points included overall survival (OS) and safety. The data cutoff date was June 28, 2024. Results: A total of 450 pts were enrolled (n = 225 in each arm). All pts completed surgery and RT and 224 in each arm received ≥1 dose of adjuvant treatment. Median study follow-up was 28.6 mo (range, 2.0-62.5). The 24-mo RFS rate was 78.3% (95% CI, 71.5-83.7) for pembro vs 68.6% (95% CI, 61.1-75.0) for pbo (HR 0.76 [95% CI, 0.53-1.10] P = 0.07243, which did not cross the p-value boundary of 0.0160 for statistical significance). On subset RFS analysis, pts with extracapsular extension (HR 0.44; 95% CI, 0.24-0.79), pts aged ≥65 years (HR 0.61; 95% CI, 0.41-0.91), and non-smokers (HR 0.58; 95% CI, CI 0.37-0.90) appeared to benefit most from pembro. Locoregional recurrence occurred in 13.8% of pts receiving pembro vs 25.3% receiving pbo; distant metastasis in 4.4% vs 11.6% of pts; and new high-risk primary cSCC in 0% vs 2.7% of pts. The 24-mo OS rate was 87.3% (95% CI, 81.5-91.5) in the pembro arm vs 90.7% (95% CI, 85.2-94.3) in the pbo arm (HR 1.47 [95% CI, 0.87-2.48]). Treatment-related AEs (TRAEs) occurred in 63.8% of pts in the pembro arm and 41.1% in the pbo arm (grade 3-4 in 7.6% and 2.7%). No pts died due to TRAEs. TRAEs led to treatment discontinuation in 5.4% of pts in the pembro arm and in 1.3% in the pbo arm. Conclusions: Pembro did not provide significant benefit in the adjuvant setting for pts with resected, high-risk LA cSCC. The safety profile of adjuvant pembro was consistent with reports from similar studies and there were no treatment-related deaths. The study was stopped for futility as the benefit/risk profile did not support continuing the trial based on recommendations from the data monitoring committee. Clinical trial information: NCT03833167 .

  PublisherDOI

• Abstract PR006: High melanoma-specific survival in patients with desmoplastic melanoma treated with single agent anti-PD-1 in SWOG S1512

  Cancer Immunology Research · 2025-02-23 · 1 citations

  article

  Abstract Desmoplastic melanoma is a rare subtype of cutaneous melanoma defined by extensive fibrosis (desmoplasia), and at the same time has pre-existing immune infiltrates and a high tumor mutational burden (TMB) resulting from exposure to ultraviolet (UV) light, which we hypothesized may result in high response rates to single-agent anti-programmed death protein 1 (PD-1) therapy. SWOG S1512 was a two-cohort phase 2 clinical trial: i) Cohort A included 28 eligible patients with surgically resectable desmoplastic melanoma who received a median of 3 infusions (range 1- 4) of neoadjuvant pembrolizumab 200 mg every 3 weeks, followed by surgical excision. pCR rate was 57% (95% CI: 37%-76%, p&amp;lt;0.001); none of the patients received adjuvant pembrolizumab (Kendra et al. ASCO 2022). ii) Cohort B included 27 eligible patients with unresectable desmoplastic melanoma who received a median of 15 infusions (range 1- 34) of pembrolizumab, 200 mg IV every 3 weeks. The objective response rate was 89% (95%, CI:71%-98%; Kendra et al. AACR 2023). At 3 years of follow-up, 13 patients have died (4 cohort A, 9 cohort B). Causes of death were: melanoma (1), cardiac (4), infections (2), stroke (1), pulmonary fibrosis (1), kidney failure (1), acute myelogenous leukemia (1), brain bleed related to a fall (1), and unknown (1). The combined 3-year melanoma-specific survival is 96% (n=55, 95%CI 87%-99%). In conclusion, patients with desmoplastic melanoma are exceptional responders to single-agent PD-1 blockade therapy, leading to long-term responses. Funding for this research was provided by NIH/NCI grants: U10CA180888 and U10CA180819 (SWOG); and in part by Merck Sharp &amp; Dohme LLC, a subsidiary of Merck &amp; Co., Inc., Rahway, NJ, USAFigure 1. Melanoma-specific survival in the combined cohorts A and B of S1512 (n = 55) at 3-year follow up. Death from other causes were treated as competing risks using the Fine-Gray model. Citation Format: Kari L kendra, shay l Bellasea, Zeynep Eroglu, Siwen Hu-Lieskovan, Katie M Campbell, William Carson III, David Wada, Jose A Plaza, Jeffery A Sosman, Gino In, Alexandra P Ikeguchi, John Hyngstrom, Andrew Brohl, Bartosz Chmielowski, Nikhil Khushalani, Joseph Markowitz, George Negrea, Samer Kasbari, Gary C Doolittle, Umang Swami, Toni Roberts, Marcus Monroe, Carlo Contreras, Edmidio Medina, Ignacio Baselga-Carretero, Cynthia R Gonzalez, Ivan Perez Garcilazo, Agustin Vega-Crespo, Jia Min Chen, nataly Nasar Al-Deen, Kenneth F Grossman, Vernon Sondak, elad sharon, Sapna P Patel, james moon, Michael C Wu, Antoni Ribas. High melanoma-specific survival in patients with desmoplastic melanoma treated with single agent anti-PD-1 in SWOG S1512 [abstract]. In: Proceedings of the AACR IO Conference: Discovery and Innovation in Cancer Immunology: Revolutionizing Treatment through Immunotherapy; 2025 Feb 23-26; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Immunol Res 2025;13(2 Suppl):Abstract nr PR006.

  PublisherDOI

• Medullary thyroid cancer arising from a thyroid rest: a case report

  Journal of Surgical Case Reports · 2025-08-01 · 1 citations

  articleOpen accessSenior author

  Medullary thyroid carcinoma (MTC) is rare and originates from parafollicular C cells and most cases present with a primary thyroid lesion. This report describes a 67-year-old woman with a left-sided neck mass and no evidence of intrathyroidal disease. Positron emission tomography-computed tomography (PET-CT) revealed paratracheal lymphadenopathy; other imaging and TSH were unremarkable. Fine-needle aspiration was inconclusive, and excisional biopsy suggested high-grade metastatic neuroendocrine carcinoma, initially suspected to be pulmonary due to thyroid transcription factor-1 (TTF-1) positivity. Pathology review raised concern for MTC. Endocrine evaluation showed elevated calcitonin (25.4 pg/ml) and carcinoembryonic antigen (CEA) (20.1 ng/ml). She denied personal or family history of thyroid disease or multiple endocrine neoplasia syndromes. Total thyroidectomy with central neck dissection was performed. All thyroid sections stained negative for calcitonin, excluding C cell hyperplasia or intrathyroidal MTC. Lymph node morphology and immunoprofile supported metastatic MTC arising from a thyroid rest. This is a rare entity, with only two other cases documented in the literature.

  PublisherDOI

• Evaluating the Accuracy of ChatGPT in Common Patient Questions Regarding HPV+ Oropharyngeal Carcinoma

  Annals of Otology Rhinology & Laryngology · 2024-07-29 · 6 citations

  article

  OBJECTIVES: Large language model (LLM)-based chatbots such as ChatGPT have been publicly available and increasingly utilized by the general public since late 2022. This study sought to investigate ChatGPT responses to common patient questions regarding Human Papilloma Virus (HPV) positive oropharyngeal cancer (OPC). METHODS: This was a prospective, multi-institutional study, with data collected from high volume institutions that perform >50 transoral robotic surgery cases per year. The 100 most recent discussion threads including the term "HPV" on the American Cancer Society's Cancer Survivors Network's Head and Neck Cancer public discussion board were reviewed. The 11 most common questions were serially queried to ChatGPT 3.5; answers were recorded. A survey was distributed to fellowship trained head and neck oncologic surgeons at 3 institutions to evaluate the responses. RESULTS: A total of 8 surgeons participated in the study. For questions regarding HPV contraction and transmission, ChatGPT answers were scored as clinically accurate and aligned with consensus in the head and neck surgical oncology community 84.4% and 90.6% of the time, respectively. For questions involving treatment of HPV+ OPC, ChatGPT was clinically accurate and aligned with consensus 87.5% and 91.7% of the time, respectively. For questions regarding the HPV vaccine, ChatGPT was clinically accurate and aligned with consensus 62.5% and 75% of the time, respectively. When asked about circulating tumor DNA testing, only 12.5% of surgeons thought responses were accurate or consistent with consensus. CONCLUSION: ChatGPT 3.5 performed poorly with questions involving evolving therapies and diagnostics-thus, caution should be used when using a platform like ChatGPT 3.5 to assess use of advanced technology. Patients should be counseled on the importance of consulting their surgeons to receive accurate and up to date recommendations, and use LLM's to augment their understanding of these important health-related topics.

  PublisherDOI

• Risk Prediction Models for Head and Neck Cancer in the US Population from the INHANCE Consortium

  UNC Libraries · 2024-03-12

  articleOpen access

  Head and neck cancer (HNC) risk prediction models based on risk factor profiles have not yet been developed. We took advantage of the large database of the International Head and Neck Cancer Epidemiology (INHANCE) Consortium, including 14 US studies from 1981-2010, to develop HNC risk prediction models. Seventy percent of the data were used to develop the risk prediction models; the remaining 30 were used to validate the models. We used competing-risk models to calculate absolute risks. The predictors included age, sex, education, race/ethnicity, alcohol drinking intensity, cigarette smoking duration and intensity, and/or family history of HNC. The 20-year absolute risk of HNC was 7.61 for a 60-year-old woman who smoked more than 20 cigarettes per day for over 20 years, consumed 3 or more alcoholic drinks per day, was a high school graduate, had a family history of HNC, and was non-Hispanic white. The 20-year risk for men with a similar profile was 6.85. The absolute risks of oropharyngeal and hypopharyngeal cancers were generally lower than those of oral cavity and laryngeal cancers. Statistics for the area under the receiver operating characteristic curve (AUC) were 0.70 or higher, except for oropharyngeal cancer in men. This HNC risk prediction model may be useful in promoting healthier behaviors such as smoking cessation or in aiding persons with a family history of HNC to evaluate their risks.

  PublisherDOI

• Clinical outcomes after adjuvant anti-PD1 therapy for high-risk resectable melanoma and predictors of response.

  Journal of Clinical Oncology · 2024-06-01

  article

  e21502 Background: Adjuvant anti-PD1 is the standard of care for high-risk resectable melanoma but many still suffer recurrence. We report a single institution observational study of patients who received adjuvant anti-PD1 with a particular focus on those who recurred. Methods: Through an approved protocol by Huntsman Cancer Institute IRB, patients with resected high-risk melanoma who first received anti-PD1 in the adjuvant setting were consented and followed. Clinical outcomes were assessed per RECIST 1.1, progression free survival (PFS), and overall survival (OS). Results: 186 eligible patients were included, 105 male and 81 females, median age at C1D1 58 (22-93), 12/161/7 at stage II/III/IV and 5 unstageable. Subtypes included 79 (43%) superficial spreading, 50 (27%) nodular, 16 (9%) lentigo/nevoid, 13 (7%) non-acral skin (NOS), 10 (5%) acral, 4 (2%) mucosal, and 14 (7%) others. With median follow up of 708 days (23-9599), 66 (35.5%) had progressive disease (PD), including 33 (50%) early PD and 33 (50%) late PD. Statistically significant predictors of worse outcome included age &gt; 50 (OS p = 0.043), acral subtype (PFS p = 0.023), PD-L1 IHC &lt; = 1% (OS p = 0.052, PFS p = 0.002), duration of treatment &lt; 3 months (OS p = 0.005, PFS p = 1.8E-07), early PD (OS p = 0.003, PFS p = 1.5E-6) and distant recurrence (OS p = 0.002). Trends that were not significant included: male gender (worse OS), BRAF mutation (better PFS), NF1 mutation (better PFS). No correlation between outcomes and TMB, NRAS, TERT mutation, and primary location. In the early/late PD groups, median age was 57/55 (range 28-79 / 25-84), 64/61% male, 1/0, 29/31, 3/2 stage II, III, IV. 17/13 were superficial spreading, 6/10 nodular, 2/5 acral, 2/2 lentigo, 1/0 mucosal and 4/3 other non-acral skin. Primary site was 12/12 head/neck, 9/5 trunk, 4/7 upper limb, 8/9 lower limb. BRAF was 9/11 wildtype, 15/9 mutant and 9/13 unknown. PD-L1 &gt; = 1% by IHC was 4/2. TMB mut/mb &gt; 10 was 6/5. Sites of recurrence included 6/12 local, 7/7 regional LN, 20/14 distal (3/1 in brain) relapses. For unresectable PD (13/13 early/late) response to next line systemic therapy is shown in Table 1. Conclusions: One third of patients developed PD after adjuvant anti-PD1 for high-risk melanoma. PD-L1 negativity and short duration of treatment was associated with worse outcome. Early PD corresponded to more distant metastasis, poorer OS and response to subsequent systemic therapy. Importantly most late PD can still have a favorable response by resuming anti-PD1 therapy. Further molecular study is ongoing to investigate mechanisms of resistance. [Table: see text]

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Recent grants

• NIH Grant R21DE027178

  NIH · $419k · 2021

Frequent coauthors

• Mia Hashibe

  Huntsman Cancer Institute

  54 shared

• Ying J. Hitchcock

  University of Utah

  54 shared

• Luke Buchmann

  Huntsman Cancer Institute

  52 shared

• Jason P. Hunt

  University of Utah

  48 shared

• Shane Lloyd

  Columbia University

  43 shared

• Richard B. Cannon

  University of Utah

  38 shared

• Michael Newman

  University of Utah

  23 shared

• Sarah Abdelaziz

  Nathan Kline Institute for Psychiatric Research

  22 shared