Cutaneous head and neck squamous cell carcinoma metastatic to parotid and cervical lymph nodes

Abstract

Nonmelanoma skin cancers occur at an epidemic rate in Australia and are increasing in incidence worldwide. In most patients, local treatment is curative. However, a subset of patients will be diagnosed with a high-risk cutaneous squamous cell carcinoma (SCC) and are defined as patients at increased risk of developing metastases to regional lymph nodes. Patients with high-risk SCC may be identified based on primary lesion and patient factors. Most cutaneous SCC arises on the sun-exposed head and neck. The parotid and upper cervical nodes are common sites for the development of metastases arising from ear, anterior scalp, temple/forehead, or scalp SCC. The mortality and morbidity associated with high-risk cutaneous SCC is usually a consequence of uncontrolled metastatic nodal disease and, to a lesser extent, distant metastases. Patients with operable nodal disease have traditionally been recommended for surgery. The efficacy of adjuvant radiotherapy has previously been questioned based on weak evidence in the early literature. Recent evidence from larger studies has, however, strengthened the case for adjuvant radiotherapy as a means to improve locoregional control and survival. Despite this, many patients still experience relapse and die. Research aimed at improving outcome such as a randomized trial incorporating the addition of chemotherapy to adjuvant radiotherapy is currently in progress in Australia and New Zealand. Ongoing research also includes the development of a proposed new staging system and investigating the role of molecular factors such as the epidermal growth factor receptor.

Poor Outcomes in Head and Neck Non-Melanoma Cutaneous Carcinomas

“…Reports in the literature have cited higher incidences of recurrence in immunosuppressed patients which follows intuitively [5]. Interestingly, in our cohort, there was a statistically significantly higher incidence of recurrent disease in patients without immunosuppression.…”

“…In other studies, immunosuppression has been noted to increase the incidence of poor outcomes in nonmelanoma squamous cell carcinomas [5]. The minimal number of patients with immunosuppression in the BCC group did not allow for rigorous statistical analysis.…”

“…Histopathologic factors such as lymphovascular invasion, poorly differentiated histology, perineural invasion, depth of invasion, and lesion size have been associated with lymph node metastases and recurrence [1]. Patient factors such as a history of immunosuppression have also been identified as a potential risk factor for poor outcomes in patients with NMCC [5].…”

Tumor necrosis factor-related apoptosis-inducing ligand induces apoptotic cell death through c-Jun NH2-terminal kinase activation in squamous cell carcinoma cells

“…Conventional therapy, including surgery, adjuvant chemotherapy and radiation, has improved the quality of life for OSCC patients (23,24), but recurrent and/or distant metastases are a major obstacle to survival (3,4). The molecular mechanisms of metastasis remain incompletely understood.…”

“…Although conventional treatments, including surgery, adjuvant chemotherapy and radiotherapy have some efficacy, survival rates have not improved significantly, partly because of local recurrence and/or distant metastases (3,4). Although the molecular mechanisms of tumor development and metastases are not completely understood, induction of apoptosis has been demonstrated to be involved in tumor metastases in some cell types (5,6).…”