Invasive head and neck cutaneous squamous cell carcinoma: clinical and histopathological characteristics, frequency of local recurrence and metastasis

Abstract

BACKGROUNDsquamous cell carcinoma is the second most common type of skin malignancy and may evolve to regional lymph node and distant metastases. OBJECTIVEThe objective of this study was to evaluate patients with head and neck cutaneous squamous cell carcinoma to identify its clinical and histopathological characteristics, as well as the frequency of local recurrence and metastasis. METHODSA retrospective cohort of patients with head and neck cutaneous squamous cell carcinoma. Inclusion criteria: histopathological confirmation, follow-up for longer than one year after diagnosis. Exclusion criteria: immunosuppression; lip and oral cavity squamous cell carcinoma; and non-surgical resection of the lesion. We evaluated demographic, clinical and anatomopathologic findings and explored their associations.RESULTSSixty-one patients with 79 tumors and followed by 4.8±3.0 years were selected. The average age was 67.1 years, and 63% of tumors had up to two centimeters. Seven tumors (8.9%) recurred and two of them had positive margins. Recurrence was associated with higher Broders' grade (p<0.01). Two patients (3.3%) had regional lymph node metastases. There were no distant metastases. Seventy tumors were considered to be usual tumors (89.7%), and 68 (87.2%) were classified as Broders' grade 1 and 2. Additionally, 64.1% of tumors had a depth of invasion below four millimeters. Thirteen tumors (16.7%) had positive histological margins. CONCLUSIONSMost patients had good prognosis in the first year of follow-up, confirming that head and neck cutaneous squamous cell carcinoma has a better prognosis than squamous cell carcinoma of other regions such as mucosa, oral cavity, and internal organs.

Risk Factors for Cutaneous Squamous Cell Carcinoma Recurrence, Metastasis, and Disease-Specific Death

“…For the purpose of the present study, PNI was analyzed as a binary variable, including 6 articles, and was associated with an RR of local recurrence (RR [95% CI], 4.30 [2.80–6.60]; P <.01). 8,14,24,33,34,41 A report by Karia et al 6 also indicated that the RR increases with the size of the involved nerve, with RR (95% CI) of regional recurrence for nerves <0.1 mm in diameter of 5.6 (2.0–15.9) ( P =.001) compared with nerves ≥0.1 mm in diameter (RR [95% CI], 10.4 [4.4–24.7]; P <.001). Interestingly, the AJCC Seventh Edition staging system for cSCC 44 includes PNI as a binary variable for high risk, whereas the BWH staging system includes PNI as a risk factor when the involved nerve is ≥0.1 mm in diameter.…”

“…Tumor location on the temple, although not part of the AJCC, UICC, or BWH staging system, 44 was associated with a higher risk of recurrence (RR [95% CI], 3.20 [1.1–9.0]; P =.03) than tumor location on either lip or ear, albeit this finding was based on a single, but relatively large, retrospective analysis by Schmults et al 8 Poor differentiation also was found to have statistically significant association with recurrence (RR [95% CI], 2.66 [1.72–4.14]; P <.01), based on pooled data from 11 studies. 4,6,17,19,22–24,34,37,39,41 …”

A Network Meta‐Analysis of Non‐Melanoma Skin Cancer (NMSC) Treatments: Efficacy and Safety Assessment

“…It is reported that BCC occupies up to 30% of the white people in their lifetimes [Wong et al, 2003], making it the most common cutaneous lesion classification and its incidence has been remarkably increasing 3-10% annually [de Vries et al, 2005;Holterhues et al, 2010;Roewert-Huber et al, 2007]. It is often presented as translucency to fleshy color vessels in BCC and a red, crusted or scaly patch in SCC, and could cause cosmetic influence as well as has a certain degree of metastatic risk, especially the SCC subgroup [Vasconcelos et al, 2014]. In the USA, 180,000-400,000 cases of SCC happened in 2013 [Karia et al, 2013].…”

Synchronous lymphoma and metastatic squamous cell carcinoma in a patient with bilateral abnormal axillary lymph nodes

“…Systemic ALCL‐ALK− presentation is typically later than for ALK positive disease with a median age of 58 years, is more common in men and has a worse prognosis because of poorer treatment response . ALCL‐ALK− has less than 50% long‐term disease‐free survival rate compared with more than 70% for ALK positive …”