Elective Neck Dissection for Head and Neck Cutaneous Squamous Cell Carcinoma with Skull Base Invasion

Abstract

Objectives Skull base invasion from cutaneous squamous cell carcinoma (cSCC) via perineural spread affects survival and the rate of regional metastasis. Our objective is to investigate the factors associated with elective neck dissection (END) in this population and the survival difference with END compared with observation for patients with a cN0 neck. Study Design Case series with chart review. Setting Academic. Subjects and Methods Patients were treated surgically for head and neck cSCC with skull base invasion via perineural spread with a cN0 neck from 2004 to 2014. Clinicopathologic data were collected and analyzed. Primary outcomes were disease-free survival (DFS) and overall survival (OS). Results Fifty-nine patients met inclusion criteria: 28 underwent an END and 31 underwent neck observation. Free tissue transfer reconstruction was significantly associated with END ( P < .001). Patients treated with an END had significantly improved 5-year DFS (57% and 32%, P = .042) and OS (60% and 37%, P = .036) compared with those who were observed and a significantly reduced rate of regional recurrence (9% and 37%, P = .024). The rate of occult nodal metastasis identified with END was 36% and is approximately equal to the regional failure rate of the neck observation group (37%). Conclusion END was more commonly used in cases requiring free tissue transfer. The use of END for head and neck cSCCs that have invaded the skull base is not routinely performed but was found to be associated with a survival advantage and reduced regional recurrence rate.

European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 2. Treatment

“…Elective (prophylactic) lymph node dissection is not recommended in the management of lymph nodeenegative cSCC patients, due to the low rate of nodal metastases, associated morbidity from the dissection and limited evidence in patients with mucosal head and neck SCC, a type of cancer with a significantly higher rate of nodal involvement [42,43]. A metaanalysis (17 studies) in patients with mcSCC to the parotid with no clinically evident cervical disease reported that the overall prevalence of occult disease was 22.5%.…”

Cutaneous Squamous Cell Carcinoma: From Pathophysiology to Novel Therapeutic Approaches

“…The indicated surgical treatment in case of nodal metastasis is therapeutic regional lymph node dissection [3,8,150]. Elective or prophylactic lymph node dissection in cases of patients affected by cSCC with negative lymph node is not recommended, given the low rate of nodal metastases, the high morbidity, and the limited evidence in patients with mucosal head and neck cSCC [154,155].…”

Integrated care pathways and the hub-and-spoke model for the management of non-melanoma skin cancer: A proposal of the Italian Association of Hospital Dermatologists (ADOI)

“…11,59,60 Considering patients affected by SCC and negative lymph node, an elective or prophylactic lymph node dissection is not recommended due to the low rate of nodal metastases, the high morbidity and the limited evidence in patients with mucosal head and neck SCC. 61,62…”