Cutaneous head and neck SCCs and risk of nodal metastasis – UK experience
Introduction
Cutaneous squamous cell carcinomas (CSCCs) comprise approximately 20% of non-melanotic skin cancers and are the second most common type of skin cancer after basal cell carcinomas in the head and neck area. They are associated with exposure to ultraviolet light and hence the majority of these lesions occur in sun-exposed areas of the head and neck (Kwa et al., 1992, Salasche, 2000, Alam and Ratner, 2001).
These CSCCs have the potential to metastatise to both the intraglandular lymph nodes of the parotid and the lymph nodes in the neck. The exact rate of lymph node metastasis remains uncertain and several papers have suggested significant variation in the risk of metastatic spread (from 0.3% to 20.7%) (Rowe et al., 1992, Kraus et al., 1998, Cherpelis et al., 2002, Moore et al., 2005). The current study is designed to identify this risk in a UK population.
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Methods
A retrospective study of all patients who had CSCC of the head and neck areas treated with surgical excision alone between January 2000 and December 2002 was performed. The patients were identified by searching the histopathological hospital database. All patients were treated in the oral and maxillofacial department covering the West Sussex region. The population in this region of UK has a high number of elderly people and has very low ethnic diversity. Those squamous cell carcinomas (SCCs)
Results
Among 194 patients who had CSCC of the head and neck area treated with surgical excision in the reference period, 143 were men and 51 were women. The male to female ratio was 2.8:1. Ages ranged from 62 to 104 years and the highest incidence was in the age group of 81–90 years (Fig. 1).
Over a period of 3 years, 218 CSCCs were excised from this group of 194 patients. Twenty patients had more than one CSCC treated with surgical excision. The scalp was the most common site, followed by the ear and
Discussion
The CSCC is a common malignancy of the head and neck region. The incidence of CSCC increases with age and appears to be related to cumulative sun exposure (Pohl, 2000). There is a male predominance. The site distribution of the CSCCs has a gender disparity: in males, more than half (54%) of CSCCs were excised from the scalp and the ear, whereas in females, most (60%) occurred in the forehead and cheek.
The high percentage of scalp lesions with a diameter of greater than 40 mm may be related to a
Conclusions
The rate of regional metastasis following the surgical excision of cutaneous head and neck SCC was 5.15% in this UK population and the parotid gland was found to be the most favoured site. Patients with a poorly differentiated SCC located on the ear and incomplete excision margins were at the greatest risk for developing regional lymph node metastasis. This group of patients requires very close follow up and may be candidates for adjuvant intervention, such as sentinel node biopsy. This latter
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