High‐risk cutaneous squamous cell carcinoma of the head and neck

Abstract

BACKGROUNDMost patients with cutaneous squamous cell carcinoma (cSCC) of the head and neck (HN) are at low‐risk (< 5%) of developing metastatic SCC to regional lymph nodes. However, patients with unfavorable clinicopathologic factors often are under appreciated by clinicians but remain at higher risk for developing metastatic lymph node disease and dying.METHODSPatients were identified who had metastatic cSCC to lymph nodes (parotid and cervical) of the HN and who were treated within the context of a multidisciplinary HN cancer service between 1980 and 2005 at Westmead Hospital (Sydney, Australia). Relevant patient details and data from primary lesions were analyzed and reported.RESULTSIn total, 266 patients were treated with curative intent. The median patient age was 69 years among 219 males and 47 females. The majority of metastatic lymph nodes (162 of 266 lymph nodes; 61%) were located in the parotid with or without cervical lymph node involvement. The median tumor thickness was 6 mm (range, 0.5–28 mm), and the median tumor size was 15 mm (range, 3–70 mm). Most tumors (65%) that measured ≥5 mm in thickness, and 30% of patients had lesions that measured ≥2 cm in greatest dimension. Recurrent cSCC was present in 15% of patients, and most lesions were located within the lymphatic drainage of the parotid on the temple/forehead (28%), on or around the ear (20%), or on the cheek (12%). Forty‐six percent of patients had moderately or poorly differentiated cSCC, and 5% of patients were immunosuppressed. A minority of patients (27%) did not have an identifiable index lesion.CONCLUSIONSData from this large, prospective data base, in concordance with other series, suggested that a patient with thick cSCC (>4–5 mm) located in proximity to the parotid gland can be considered at high‐risk. Increasing lesion size and recurrence contribute to this risk. Cancer 2006. © 2006 American Cancer Society.

A programme of research to set priorities and reduce uncertainties for the prevention and treatment of skin disease

“…In our univariate analysis, we found an association between local recurrence and the presence of perineural invasion, which is consistent with other studies. 673,698 Local recurrence was also associated with the presence of vascular invasion in our study. Poorly differentiated and undifferentiated tumours were significantly associated with increased mortality at 5 years from any cause and patients with such tumours were less likely to be alive with no history of recurrence at 5 years.…”

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

“…Other anatomic pathologic criteria of the tumor should be considered, such as depth of invasion, histological differentiation grade, presence of perineural and lymphovascular invasion, because many patients in stages T1 and T2 may develop regional and distal metastases. 3,17 …”

“…16,21 Veness et al found 15% of recurrence in patients who had metastatic disease. 3 Another study found that 50% of SCC lesions with positive margins recurred with consequent increased risk of developing metastases. 22 …”

“…A depth of invasion greater than 4 mm is an important predictor for regional lymph node metastases. 3,23 A study of head and neck SCC showed that only 17% of patients had metastases when their lesions were smaller than 4-mm deep, compared with 83% of patients with metastases when their lesions were larger than 4 mm in depth. 6 …”

“…Chemical products (such as arsenic and polycyclic hydrocarbons), human papilloma virus infections, immunosuppression, scars, and other chronic ulcerated dermatoses are other less frequent risk factors for the development of cutaneous SCC. 3,4 …”