Elective management of regional nodal basins in cutaneous squamous cell carcinoma of the head and neck: Controversies and contemporary perspectives

• Published in: Oral oncology Vol. 120; p. 105432
• Main Authors: Wilkie, Mark D., Lancaster, Jeffrey, Roland, Nicholas J., Jones, Terence M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.09.2021
• Subjects: Cutaneous malignancy; Head and neck neoplasms; Head and Neck Neoplasms - surgery; Humans; Lymph Nodes; Lymphatic Metastasis; Sentinel Lymph Node Biopsy; Skin Neoplasms - surgery; Squamous cell carcinoma; Squamous Cell Carcinoma of Head and Neck - surgery; Lymphatic metastasis; Squamous cell carcinoma; Cutaneous malignancy; Head and neck neoplasms; Sentinel lymph node biopsy
• ISSN: 1368-8375; 1879-0593
• DOI: 10.1016/j.oraloncology.2021.105432

•cSCC is the commonest cause of NMSC mortality largely due to propensity for LNM.•Whilst overall LNM rates are low, several factors confer significantly higher risks.•More proactive approaches to elective treatment of nodal basins have been proposed.•SLNB is emerging as a promising strategy in cSCCHN and merits investigation in a RCT.•First, further high-quality study to provide clarity on patient selection is required. Non-melanoma skin cancer (NMSC) is among the most common cancers worldwide, with an incidence that continues to rise. Although cutaneous squamous cell carcinoma (cSCC) constitutes only approximately 20% of such cases, it represents the most common cause of NMSC mortality, owing largely to the propensity for development of regional lymph node metastases (LNM), which, when present, carry a dismal prognosis. Whilst overall rates of LNM are low, there are a number of patient and tumour factors that likely confer considerably higher risks, which has led several investigators to propose more proactive elective management of regional nodal basins in selected high-risk cases. Current international guidelines, however, do not recommend any elective treatment or sampling of regional nodal basins in the absence of clinically apparent disease. The purpose of this review is to explore in detail the fundamental issues underlying this controversy, focusing specifically on cSCC of the head and neck (cSCCHN). In particular the rationale for more a proactive elective approach to regional nodal basins, including the evidence-base underlying identification of potentially high-risk factors for development of LNM is discussed, along with oncological outcomes for those patients that do go onto suffer LNM. We also provide contemporary perspectives and evidence for approaches to electively managing regional nodal basins, and offer insight into how these may develop both in the clinical and research arenas.