Analysis of selected risk factors for nodal metastases in head and neck cutaneous squamous cell carcinoma

Abstract

Cutaneous squamous cell carcinoma (cSCC) accounts for 20 % of all skin malignancies and 20 % of deaths. In contrast to mucosal SCC, treatment results are very good. However, regional metastases are present in 5–20 % of cases, and the prognosis for patients with metastases is 50 % lower. It has been reported that several risk factors are responsible for the head and neck lymph node regional metastasis, such as: poor cell differentiation, local recurrence, immunosuppression, and tumour dimension. Multivariate analysis of metastatic neck lesions in head and neck cSCC. Retrospective analysis of patients treated at our department for head and neck cSCC. The study includes 100 patients: 66 males (66 %) and 34 females (34 %), aged 26–98 years (mean age 74.6). The tumour was evaluated for: sex predilection, local recurrence, stage (according to 7th edition of American Joint Committee on Cancer TNM staging), differentiation, and site. Most patients (79 cases; 79 %) were treated for primary cSCC, while the other 21 patients presented local recurrence of cSCC. Neck metastases were diagnosed in five patients with primary cSCC and in three with recurrent cSCC. No distant metastasis was observed. The most common tumour location was the auricle (29 cases; 29 %). Neck dissection was performed most frequently in patients with lip tumours (17/22 cases; 77 %). Neck metastasis was diagnosed most often in patients with cSCC on the lip (2 patients) and buccal region (2 patients). The most common tumour location in males was the auricle (25/66 cases; 38 %) whereas in females the nasal and buccal regions were the most common locations, with 8 patients each (8/34 cases; 23 %). Neck dissection was performed in 20 of the 66 males (30 %) and in 12 of the 34 females (35 %). Neck metastasis was confirmed in 5 females (15 %) and 3 males (5 %). The most common histopathological tumour stage was G2 (57 cases; 57 %). Of the eight patients with confirmed neck metastasis, four had poorly-differentiated (histopathological stage G3). Thus, 4 of the 24 patients (17 %) with stage G3 tumours experienced metastasis. Our findings suggest that factors such as local recurrence, degree of cell differentiation, tumour dimension and/or location, can increase the risk of neck metastases. For this reason, in patients with such risk factors, neck dissection should be considered to evaluate for metastatic lesions.

Characterisation of Prognosis and Invasion of Cutaneous Squamous Cell Carcinoma by Podoplanin and E-Cadherin Expression

“…According to Cox regression, however, histopathological grading ( ≥ G3) only tends to be an independent prognostic parameter for metastasis ( p = 0.058, Table 2 ). Recent analyses displayed a metastatic risk of G3 tumours between 17.9 and >30% [24,32,34,37,39,40] .…”

“…Table 1). Poor differentiation is correlated with an increased metastatic risk and part of the ''high-risk-features'' in the AJCC classification of cSCC [8,12,24,32,34,[36][37][38] . The univariate analysis revealed that ≥ G3 tumours are significantly associated with metastasis ( p = 0.036).…”

Prognostic variables in high‐risk cutaneous squamous cell carcinoma: a review

“…Unlike tumors on the trunk and extremities, cutaneous SCCs of the head and neck present with a higher incidence of lymph node metastasis . Certain characteristics portend a higher risk: primary tumor >2 cm, tumor thickness >4–5 mm, tumor location near the parotid gland (ear, temple, forehead, and anterior scalp), recurrent tumors, poorly differentiated or desmoplastic tumors, lymphovascular or perineural invasion and an immunocompromised host …”

“…Cutaneous squamous cell carcinoma (cutaneous SCC) is the second most common skin cancer in the United States and accounts for 20% of all non‐melanoma skin cancer . While the majority of cutaneous SCC cases have a favorable prognosis, a subset displays a more aggressive clinical trajectory including increased rates of local recurrence, lymph node metastasis and death . A standard of care has not been defined for management of these patients and no prognostic algorithms exist to predict which individuals are at risk for local recurrence or metastasis .…”

“…A standard of care has not been defined for management of these patients and no prognostic algorithms exist to predict which individuals are at risk for local recurrence or metastasis . As the presence of metastases reduces 5‐year overall survival by 50%, early identification and treatment of this subset will be beneficial …”