High-risk cutaneous squamous cell carcinoma of the head and neck : Results from 266 treated patients with metastatic lymph node disease

Most 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 de...

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Published inCancer Vol. 106; no. 11; pp. 2389 - 2396
Main Authors VENESS, Michael J, PALME, Carsten E, MORGAN, Gary J
Format Journal Article
LanguageEnglish
Published New York, NY Wiley-Liss 01.06.2006
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Abstract Most 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. Patients 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. In 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 >or=5 mm in thickness, and 30% of patients had lesions that measured >or=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. Data 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.
AbstractList 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 >or=5 mm in thickness, and 30% of patients had lesions that measured >or=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.
Most 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. Patients 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. In 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 >or=5 mm in thickness, and 30% of patients had lesions that measured >or=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. Data 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.
Author VENESS, Michael J
PALME, Carsten E
MORGAN, Gary J
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Issue 11
Keywords Human
cutaneous
High risk
Squamous cell carcinoma
Lymph node
Malignant tumor
Metastasis
metastases
Cancerology
Treatment
lymph nodes
Head and neck
ENT disease
Advanced stage
Skin
Head and neck carcinoma
Language English
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Snippet Most 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...
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...
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StartPage 2389
SubjectTerms Adult
Aged
Aged, 80 and over
Biological and medical sciences
Carcinoma, Squamous Cell - radiotherapy
Carcinoma, Squamous Cell - secondary
Carcinoma, Squamous Cell - surgery
Female
Head and Neck Neoplasms - pathology
Head and Neck Neoplasms - radiotherapy
Head and Neck Neoplasms - surgery
Humans
Lymphatic Metastasis
Male
Medical sciences
Middle Aged
Neoplasm Recurrence, Local - pathology
Otorhinolaryngology (head neck, general aspects and miscellaneous)
Otorhinolaryngology. Stomatology
Prospective Studies
Risk Factors
Skin Neoplasms - pathology
Skin Neoplasms - radiotherapy
Skin Neoplasms - surgery
Tumors
Title High-risk cutaneous squamous cell carcinoma of the head and neck : Results from 266 treated patients with metastatic lymph node disease
URI https://www.ncbi.nlm.nih.gov/pubmed/16649220
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