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Lymph node metastases from cutaneous squamous cell carcinoma of the head and neck.
Laryngoscope. 2005 Sep; 115(9):1561-7.L

Abstract

OBJECTIVE/HYPOTHESIS

Cutaneous squamous cell carcinoma (CSCC) has been reported to metastasize to parotid and cervical lymph nodes. Few prospective investigations of associated clinical and histopathologic findings and their effect on patient outcomes exist. We seek to identify risk factors for nodal metastases in CSCC and determine the impact of lymphatic spread on survival and recurrence.

STUDY DESIGN

Subset analysis of a prospective, longitudinal database of patients with CSCC at a comprehensive cancer center.

METHODS

Eligible patients with nonmelanoma skin cancer were consecutively enrolled in a prospective database from July 1996 through June 2001; this cohort was then followed to the key endpoints of recurrence and mortality.

RESULTS

Two hundred ten patients were enrolled, and 193 patients with CSCC of the head and neck are included in this analysis. The incidence of nodal metastases in this population was 20.7% at study entry. Median follow-up was 20 months in patients with lymph node metastases and 24 months in patients without metastases. Nodal metastases were significantly associated with recurrent lesions (P = .002) and the following histopathologic features: lymphovascular invasion (P < .0001), inflammation (P = .010), poorly differentiated histology (P = .001), invasion into the subcutaneous tissues (P = .0001), perineural invasion (P = .005), and larger size (P = .0007). Metastases to the cervical nodes were not clinically apparent in 42% of patients with parotid metastases. Combination surgery and radiation therapy resulted in regional control rates of 95%, although local recurrence and distant metastases, along with second primary tumors, were the most frequent recurrent events. Kaplan-Meier survival analysis demonstrates a decrease in overall survival (P = .005), disease-free survival (P = .015), disease-specific survival (P = 0002), and time to recurrence (P = .012) in patients with nodal metastases compared with controls.

CONCLUSIONS

Lymph node metastases from CSCC are common in our population and are associated with diminished survival. The presence of nodal spread occurs with other adverse histopathologic findings, and we recommend surgery and postoperative radiation therapy to control regional disease in the presence of nodal metastases and perineural invasion. New approaches in early identification of nodal metastases, treatment, and prevention of local recurrences and second primary malignancies are warranted.

Authors+Show Affiliations

Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

16148695

Citation

Moore, Brian A., et al. "Lymph Node Metastases From Cutaneous Squamous Cell Carcinoma of the Head and Neck." The Laryngoscope, vol. 115, no. 9, 2005, pp. 1561-7.
Moore BA, Weber RS, Prieto V, et al. Lymph node metastases from cutaneous squamous cell carcinoma of the head and neck. Laryngoscope. 2005;115(9):1561-7.
Moore, B. A., Weber, R. S., Prieto, V., El-Naggar, A., Holsinger, F. C., Zhou, X., Lee, J. J., Lippman, S., & Clayman, G. L. (2005). Lymph node metastases from cutaneous squamous cell carcinoma of the head and neck. The Laryngoscope, 115(9), 1561-7.
Moore BA, et al. Lymph Node Metastases From Cutaneous Squamous Cell Carcinoma of the Head and Neck. Laryngoscope. 2005;115(9):1561-7. PubMed PMID: 16148695.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lymph node metastases from cutaneous squamous cell carcinoma of the head and neck. AU - Moore,Brian A, AU - Weber,Randal S, AU - Prieto,Victor, AU - El-Naggar,Adel, AU - Holsinger,F Christopher, AU - Zhou,Xian, AU - Lee,J Jack, AU - Lippman,Scott, AU - Clayman,Gary L, PY - 2005/9/9/pubmed PY - 2005/11/3/medline PY - 2005/9/9/entrez SP - 1561 EP - 7 JF - The Laryngoscope JO - Laryngoscope VL - 115 IS - 9 N2 - OBJECTIVE/HYPOTHESIS: Cutaneous squamous cell carcinoma (CSCC) has been reported to metastasize to parotid and cervical lymph nodes. Few prospective investigations of associated clinical and histopathologic findings and their effect on patient outcomes exist. We seek to identify risk factors for nodal metastases in CSCC and determine the impact of lymphatic spread on survival and recurrence. STUDY DESIGN: Subset analysis of a prospective, longitudinal database of patients with CSCC at a comprehensive cancer center. METHODS: Eligible patients with nonmelanoma skin cancer were consecutively enrolled in a prospective database from July 1996 through June 2001; this cohort was then followed to the key endpoints of recurrence and mortality. RESULTS: Two hundred ten patients were enrolled, and 193 patients with CSCC of the head and neck are included in this analysis. The incidence of nodal metastases in this population was 20.7% at study entry. Median follow-up was 20 months in patients with lymph node metastases and 24 months in patients without metastases. Nodal metastases were significantly associated with recurrent lesions (P = .002) and the following histopathologic features: lymphovascular invasion (P < .0001), inflammation (P = .010), poorly differentiated histology (P = .001), invasion into the subcutaneous tissues (P = .0001), perineural invasion (P = .005), and larger size (P = .0007). Metastases to the cervical nodes were not clinically apparent in 42% of patients with parotid metastases. Combination surgery and radiation therapy resulted in regional control rates of 95%, although local recurrence and distant metastases, along with second primary tumors, were the most frequent recurrent events. Kaplan-Meier survival analysis demonstrates a decrease in overall survival (P = .005), disease-free survival (P = .015), disease-specific survival (P = 0002), and time to recurrence (P = .012) in patients with nodal metastases compared with controls. CONCLUSIONS: Lymph node metastases from CSCC are common in our population and are associated with diminished survival. The presence of nodal spread occurs with other adverse histopathologic findings, and we recommend surgery and postoperative radiation therapy to control regional disease in the presence of nodal metastases and perineural invasion. New approaches in early identification of nodal metastases, treatment, and prevention of local recurrences and second primary malignancies are warranted. SN - 0023-852X UR - https://www.unboundmedicine.com/medline/citation/16148695/Lymph_node_metastases_from_cutaneous_squamous_cell_carcinoma_of_the_head_and_neck_ L2 - https://doi.org/10.1097/01.mlg.0000173202.56739.9f DB - PRIME DP - Unbound Medicine ER -