Lateral Lymph Node Metastases in Papillary Thyroid Cancer

Abstract

associated with increased risk of recurrence and intracranial involvement. METHOD: A retrospective chart-review was completed for all patients diagnosed with scalp or forehead cutaneous scc at a single institution between 1999 and 2009. The diagnosis of scc was confirmed based on pathology reports. Intracranial and/or cavernous sinus involvement was confirmed based on biopsy or imaging. RESULTS: Five male patients with cutaneous scc of the scalp or forehead that developed intracranial metastases were identified. The median age at diagnosis was 68 (53 -89) years. All patients were previously treatment for scc with wide local excision. The average tumor size at diagnosis was 4.9 cm. The mean time from initial diagnosis to intracranial extension was 5.4 months. The most common presenting symptoms were headache, pain, skin paresthesia and imbalance. Patients with cavernous sinus involvement presented with diplopia secondary to abducens nerve palsy. Mean survival time from diagnosis of intracranial involvement with and without cavernous sinus involvement was 3.5 and 9.7 months, respectively. The addition of radiation therapy did not influence disease free or overall survival. CONCLUSION: Cutaneous scalp and forehead scc are highly aggressive. Despite initial treatment with wide local excision and radiation therapy, local recurrence is common. Male gender, age greater than 50, tumor size greater than 2 cm, and moderate to poor or poor histologic differentiation are associated with increased risk of tumor recurrence and intracranial involvement.