Predicting the pattern of regional metastases from cutaneous squamous cell carcinoma of the head and neck based on location of the primary

Abstract

In patients undergoing parotidectomy for metastatic cutaneous SCCHN with a clinically negative neck, the results of this study support selective neck dissection including level I-III for facial primaries, level II-III for anterior scalp and external ear primaries, and levels II-V for posterior scalp and neck primaries.

Positive survival trend in metastatic head and neck cutaneous squamous cell carcinoma over four‐decades: Multicenter study

“…Cutaneous squamous cell carcinoma (cSCC) accounts for approximately 20% of all nonmelanoma skin cancers, which is the most common malignancy worldwide . Australia has the highest rate of cSCC secondary to excess sun exposure in a largely fair‐skinned population . Although less than 5% of head and neck cSCC (HNcSCC) metastasize, lymph node metastases in the parotid and/or neck are potentially lethal and require morbid multimodal regional therapy with surgery and adjuvant radiotherapy (RT) .…”

Metastatic Cancer to the Parotid

“…The region of the external jugular lymph node adjacent to the tail of the parotid is critical [21] . Although lymphatic drainage from cutaneous tumors is unpredictable, in patients with parotid metastases, there is considerable evidence that the location of the metastases is predictive of further potential sites of nodal disease [22,23] . Routine preoperative investigations of patients with suspected parotid nodal metastases include ultrasound guided fine-needle aspiration and CT scanning of the parotid gland, neck and chest.…”

“…Therefore, in the majority of patients, the combination of parotidectomy and selective levels II/III neck dissection will allow for accurate staging of the neck. Among patients with posterior scalp primaries, 15% have level IV/V metastases; hence, in this group, dissection of levels II-V is recommended [23] . It is important to note that the external jugular node is considered part of the parotid in this context and always needs to be removed.…”

Advanced Squamous Cell Carcinoma of the Skin

“…In patients undergoing parotidectomy, Ebrahimi recommends selective neck dissection including level I to III for facial primaries, level II and III for anterior scalp and external ear primaries, and levels II to V for posterior scalp and neck primaries (Ebrahimi, Moncrieff et al 2010). Isolated metastases of level V and primary region of the scalp or posterior subocipital region, a posterior lateral neck dissection (II to V) is recommended.…”