Cutaneous head and neck SCCs and risk of nodal metastasis – UK experience

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Summary

Aim

To identify the risk of developing metastases to regional nodes in patients with cutaneous squamous cell carcinomas (CSCCs) of the head and neck.

Methods

A retrospective study of patients with CSCC treated with surgical excision alone between 2000 and 2002 was performed. Demographic details of the patients, the site, size, differentiation, depth of invasion, clearance of surgical margins, and the presence of perineural or lymphovascular invasion of the lesion were documented. During the follow up period, patients with regional metastases were identified. The site of the metastasis and the time after the primary resection were documented and statistical analysis was performed using Chi-square and logistic regression analysis.

Results

One hundered and ninety-four patients were included and 218 CSCCs were excised in total during the period of 3 years. The scalp was the most common site of skin lesion, followed by the ear. The incidence of regional metastatic disease was found to be 5.15%. The parotid gland was the most common area of regional metastasis. No metastases occurred after the first 2 years of follow up. The pinna, the poor differentiation and incomplete excision margins were found to be associated with regional metastasis independently, with odds ratio of 16, 21, and 2 respectively.

Conclusions

The rate of regional metastasis from CSCC remains low. The parotid gland was the most favoured metastatic site. Patients with poorly differentiated squamous cell carcinoma (SCC) located on the ear and incomplete excision margins were at the greatest risk for developing regional lymph node metastasis and require close follow up.

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.

Section snippets

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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