BackgroundThe extent of a neck dissection for patients with metastasis of cutaneous squamous cell carcinoma of the head and neck (HNcSCC) is still subject to debate and clear guidelines are lacking. Tumor characteristics like size, differentiation and tumor location are known risk factors for lymph node metastasis (LNM). There is some evidence that, depending on tumor location, LNM follows a specific pattern. This study aims to identify which tumor characteristics can predict the pattern and extent of LNM.MethodIn this cohort study 80 patients were included, who underwent a primary neck dissection for LNM of HNcSCC between 2003 and 2018 at the University Medical Center Groningen, the Netherlands. Retrospective data was collected for primary tumor characteristics and LNM and included surgical and follow-up data. Influence of tumor characteristics on the extent of LNM was analyzed using non-parametric tests. Logistic regression analysis were used to identify a metastasis pattern based on the primary tumor location.ResultsOnly primary tumor location was associated with the pattern of LNM. HNcSCC of the ear metastasized to level II (OR = 2.6) and the parotid gland (OR = 3.6). Cutaneous lip carcinoma metastasized to ipsilateral and contralateral level I (OR = 5.3). Posterior scalp tumors showed a metastasis pattern to level II (OR = 5.6); level III (OR = 11.2), level IV (OR = 4.7) and the parotid gland (OR = 10.8). Ear canal tumors showed a low risk of LNM for all levels. The extent of LNM was not related to age or any tumor characteristics i.e. tumor diameter, infiltration depth, differentiation grade, perineural growth and vascular invasion.ConclusionPrimary tumor location determines the LNM pattern. Whereas known unfavorable tumor characteristics did not relate to the extent of LNM. Location guided limited neck dissection combined with parotidectomy will treat most patients adequately.

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A 10-week-old newborn presenting with Staphylococcus aureus sepsis of unknown origin was referred to our nuclear medicine department for 18 F-FDG PET/CT imaging. His medical history consisted of several congenital defects, including Fallot's tetralogy and jejunal atresia. A total body 18 F-FDG PET/CT imaging was performed in 3 min (1-bed position) without sedation on the Biograph Vision Quadra system (Siemens Healthineers, Erlangen, Germany) using only 12 MBq of activity, representing less than half of the minimum activity recommended by the EANM dose chart [1]. Effective patient dose was 1.3 mSv for internal radiation (PET) [2], while external radiation from low-dose CT contributed an additional 0.65 mSv [3]. Values remained at least two times below international recommendations [1, 4]. The scan showed normal physiological uptake in the kidneys, bladder, myocardium, and developing brain, including physiological hypometabolism in the frontal This article is part of the Topical Collection on Image of the month * N. D. van Rijsewijk