One hundred thirty-eight patients receiving initial treatment for squamous cell carcinoma of the mobile tongue from 1960 to 1978 were reviewed to determine the frequency of cervical metastasis in early carcinoma (T1N0 and T2N0). Occult cervical node metastasis in an elective neck dissection or subsequent neck recurrence in an initially negative neck was found in 14.5% (9/62) of patients staged T1N0 and 30.6% (11/36) of patients staged T2N0. Refinement of the staging system demonstrated that 9.7% (3/31) of patients with a primary lesion less than or equal to 1.0 cm and a clinically negative neck (T1aN0) subsequently developed a cervical metastasis. Patients with primary lesions greater than 1.0 cm but less than or equal to 2.0 cm (T1bN0) had twice the risk of occult cervical metastasis (19.4% or 6/31). The crude 5-year survivals in Stage I for radium alone, partial glossectomy, and partial glossectomy with neck dissection were 64%, 58% and 75% respectively and in Stage II were 31%, 66% and 71% respectively. Local-regional failure is the principal mechanism of failure in patients treated locally particularly in Stage II.

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