Evolution of Head and Neck Cutaneous Squamous Cell Carcinoma Nodal Staging—An Australian Perspective

Abstract

Cutaneous squamous cell carcinoma of the head and neck (HNcSCC) is one of the commonest malignancies. When patients present with regional metastatic disease, treatment escalation results in considerable morbidity and survival is markedly reduced. Owing to the high incidence, Australian institutions have been at the forefront of advocating for reliable, accurate, and clinically useful staging systems that recognise the distinct biological characteristics of HNcSCC. As a result, an extensive body of literature has been produced over the past two decades, which has defined critical prognostic factors, critiqued existing staging systems, and proposed alternative staging models. Notwithstanding, a suitable staging system has proved elusive. The goal of cancer staging is to group patients according to cancer characteristics for which survival differs between groups (distinctiveness), consistently decreases with increasing stage (monotonicity), and is similar within a group (homogeneity). Despite implementing major changes based on published data, the latest edition of the American Joint Committee on Cancer (AJCC) staging manual fails to satisfy these fundamental requirements. This review chronologically explores and summarises the Australian contribution to prognostication and nodal staging of HNcSCC and highlights the ongoing challenges.

Metastatic patterns and treatment options for head and neck cutaneous squamous cell carcinoma (Review)

“…BCC generally experiences gradual confined growth and hardly metastasizes; by contrast, cSCC, melanoma and other types of cancer often spread to both nearby and distant locations, which can have an impact on the clinical course of the disease and the well-being of the patients ( 8 ). The early detection of individuals who are more likely to develop metastatic disease would justify the need for surveillance ( 9 ). Currently, to the best of our knowledge, there are no indicators of metastasis in cSCC other than conventional histopathological examination.…”

Aggressive Cutaneous Squamous Cell Carcinoma of the Head and Neck: A Review

“…AJCC7 stratified patients for the first time on nodal number, size, and laterality. However, it ignored the distinct biological dissimilarities between cutaneous SCC and mucosal SCC [36]. The 8th edition of the cancer staging manual by the AJCC (AJCC8), which was implemented in January 2017, recognized cutaneous squamous cell carcinoma of the head and neck as a separate entity and made several changes to the T category.…”

“…The changes made to the T1 comprised tumors with a dimension ≥ 2 cm, T2 ≥ 2cm but < 4 cm, T3 ≥ 4 cm or minimal bone erosion or perineural invasion (PNE) or deep invasion. T4 was divided into T4a (extensive cortical or marrow invasion) and T4b (cranium-based invasion) [36]. AJCC8 also introduced ENE (Extranodal extension) for the first time in the N category.…”