The Effect of Tumor Characteristics and Location on the Extent of Lymph Node Metastases of Head and Neck Cutaneous Squamous Cell Carcinoma

Abstract

BackgroundThe extent of a neck dissection for patients with metastasis of cutaneous squamous cell carcinoma of the head and neck (HNcSCC) is still subject to debate and clear guidelines are lacking. Tumor characteristics like size, differentiation and tumor location are known risk factors for lymph node metastasis (LNM). There is some evidence that, depending on tumor location, LNM follows a specific pattern. This study aims to identify which tumor characteristics can predict the pattern and extent of LNM.MethodIn this cohort study 80 patients were included, who underwent a primary neck dissection for LNM of HNcSCC between 2003 and 2018 at the University Medical Center Groningen, the Netherlands. Retrospective data was collected for primary tumor characteristics and LNM and included surgical and follow-up data. Influence of tumor characteristics on the extent of LNM was analyzed using non-parametric tests. Logistic regression analysis were used to identify a metastasis pattern based on the primary tumor location.ResultsOnly primary tumor location was associated with the pattern of LNM. HNcSCC of the ear metastasized to level II (OR = 2.6) and the parotid gland (OR = 3.6). Cutaneous lip carcinoma metastasized to ipsilateral and contralateral level I (OR = 5.3). Posterior scalp tumors showed a metastasis pattern to level II (OR = 5.6); level III (OR = 11.2), level IV (OR = 4.7) and the parotid gland (OR = 10.8). Ear canal tumors showed a low risk of LNM for all levels. The extent of LNM was not related to age or any tumor characteristics i.e. tumor diameter, infiltration depth, differentiation grade, perineural growth and vascular invasion.ConclusionPrimary tumor location determines the LNM pattern. Whereas known unfavorable tumor characteristics did not relate to the extent of LNM. Location guided limited neck dissection combined with parotidectomy will treat most patients adequately.

Development and validation of a diagnostic model for predicting cervical lymph node metastasis in laryngeal and hypopharyngeal carcinoma

“…In the end, we included 285 patients for statistical analysis. Among them, the majority were male, accounting for 275 cases (96.5%), while there were only 10 female patients (3.5%), consistent with previous research findings ( 11 ). The median age of these patients was 61 years, with 245 cases (86.0%) having no lymph node metastasis and 40 cases (14.0%) having lymph node metastasis.…”

“…Another study ( 29 ) pointed out that lymph node metastasis in hypopharyngeal cancer is closely related to tumor staging, with advanced cases (T3-T4) being more prone to lymph node metastasis than early cases (T1-2), which is consistent with our research findings. Research suggests that tumors in different locations exhibit significant differences in lymph node metastasis ( 11 ), particularly tumors in the hypopharynx, which are considered high-risk factors for lymph node metastasis, with a metastasis rate as high as 70% ( 30 , 31 ). Additionally, hypopharyngeal cancer is more likely to metastasize to the tracheal lymph nodes ( 32 ).…”

Neck management in metastatic cutaneous squamous cell carcinoma of the head and neck

“…Approximate management of a cN0 neck is critical but has always been ignored in prior literature, which tended to clarify oncologic outcomes, occult cervical disease, or LN metastasis pattern in HNcSCC ( 13 – 15 ). To the best of our knowledge, only three studies were available for analysis of the impact of different neck managements on survival ( 10 , 16 , 17 ).…”