The significance of regional metastasis location in head and neck cutaneous squamous cell carcinoma

Abstract

Background Regional metastasis of head and neck cutaneous squamous cell carcinoma (HNcSCC) can be seen in either parotid and/or cervical lymph nodes. The aim of this study was to assess whether there was a difference in prognosis between parotid and cervical nodal metastases. Methods Patients with regional metastasis from HNcSCC were identified from an institutional database. Disease‐specific (DSS) and overall survival (OS) were calculated using the Kaplan–Meier method and Cox proportional hazards models. Results Five hundred and thirty‐five patients were identified with median follow‐up of 26.4 months (3–255 months). Two hundred and thirty‐five patients had parotid metastasis, 96 patients had neck metastasis, and 204 patients had both. On multivariable analysis, any regional metastasis to the neck when compared to parotid alone conferred worse DSS (HR 1.8, p = 0.007) and OS (HR 1.3, p = 0.024). Conclusion Regional metastasis of HNcSCC to the neck confers worse outcomes compared to metastasis to the parotid alone.

Whole genome analysis reveals the genomic complexity in metastatic cutaneous squamous cell carcinoma

“…CSCCs arising in the head and neck generally show a predictable pattern of spread, predominantly metastasizing to the intraparotid, level II (upper jugular), and perifacial lymph nodes ( 4 ). CSCCs that have metastasized to regional lymph nodes are associated with a worse prognosis ( 6 ), with modest progress made in the management of regionally advanced disease over the last 15 years. Most patients with regional metastases from CSCC of the head and neck are managed with a multimodality approach, which usually involves surgery (parotidectomy and neck dissection) and adjuvant external beam radiotherapy depending on the site and stage at the time of diagnosis ( 7 – 9 ).…”

Evolution of Head and Neck Cutaneous Squamous Cell Carcinoma Nodal Staging—An Australian Perspective

“…In this study, the presence of parotid metastasis was considered a high-risk criterion satisfying inclusion. Mooney et al in 2021 aimed to re-evaluate the impact of the location of nodal metastasis on survival in patients with HNcSCC [ 43 ]. Of the 535 patients, 235 had parotid metastases in isolation, 96 had neck metastases alone, and 204 had both.…”

DANGER: what clinicians need to know about aggressive head and neck cutaneous squamous cell carcinoma

“…5,[9][10][11] However, the most reliable prospective data come from a study published in 2021 which reported that the rate of nodal metastases for the patients with a depth of invasion of 5 mm or greater was 19.7% compared with 0% for the patients with a depth of invasion of less than 5 mm (P = 0.01), where the rate of nodal metastases in the patients with a depth of invasion of 10 mm or greater was 25%. 11 Multiple guidelines concur that depth of invasion of more than 4 mm for cSCC is considered a high risk factor and, therefore, tumours with high depth of invasion need ongoing surveillance for nodal metastases. 9,12 In addition, patients who are taking immunosuppressive drugs have a higher risk of developing cSCC, which is associated with an increasing duration of immunosuppression.…”

“…For instance, a cSCC with more than 4 mm in depth of invasion is associated with increased risk of metastasis, with those invading the subcutaneous fat having a metastatic potential up to 46% (Box 2). 5,9‐11 However, the most reliable prospective data come from a study published in 2021 which reported that the rate of nodal metastases for the patients with a depth of invasion of 5 mm or greater was 19.7% compared with 0% for the patients with a depth of invasion of less than 5 mm ( P = 0.01), where the rate of nodal metastases in the patients with a depth of invasion of 10 mm or greater was 25% 11 . Multiple guidelines concur that depth of invasion of more than 4 mm for cSCC is considered a high risk factor and, therefore, tumours with high depth of invasion need ongoing surveillance for nodal metastases 9,12 …”