Craig P Mooney1,2, Richard C W Martin3,4, Richard Dirven3,5, Bruce G Ashford3,6,7,8, Kerwin Shannon3,9, Carsten E Palme3,9, Quan Ngo10, James Wykes3,11, Sarah Davies3, Kan Gao3, Sydney Ch'ng3,9, Tsu-Hui Low3,9, Ruta Gupta3,9,12, Jonathan R Clark3,9,11. 1. Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia. craigpmooney@gmail.com. 2. Sydney Medical School, University of Sydney, Sydney, Australia. craigpmooney@gmail.com. 3. Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia. 4. Melanoma Unit, Waitemata Health and Auckland Regional Head and Neck Service, University of Auckland, Auckland, New Zealand. 5. Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands. 6. Illawarra and Shoalhaven Local Health District, Wollongong, Australia. 7. Illawarra Health and Medical Research Institute, Wollongong, Australia. 8. School of Biological Sciences, University of Wollongong, Wollongong, Australia. 9. Central Clinical School, University of Sydney, Sydney, Australia. 10. Liverpool Hospital, Liverpool, Australia. 11. South West Clinical School, University of NSW, Sydney, Australia. 12. Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia.
Abstract
BACKGROUND: Regional nodal metastases from cutaneous squamous cell carcinoma (cSCC) is strongly associated with a poor prognosis, but these metastases are difficult to predict clinically. Sentinel node biopsy (SNB) has been used for a wide range of malignancies to assess for regional nodal metastasis, but is not widely used for cSCC. METHODS: Patients presenting with high-risk cSCC of the head and neck with clinically N0 necks were offered SNB at the time of primary cSCC excision or secondary wide local excision. Patients with positive sentinel nodes were offered completion lymph node dissection, and all the patients were followed up at regular intervals for up to 5 years. RESULTS: In this study, 105 lesions underwent SNB, and 10 sentinel nodes (9.5%) were positive. In an additional five patients, regional recurrence developed after a negative sentinel node, with a total subclinical nodal metastasis rate of 14.3%. Nodal metastases were significantly associated with reduced disease-specific survival. The significant predictors of metastasis were four or more high-risk features or tumors with a concurrent invasion deeper than 5 mm and PNI. CONCLUSION: For high-risk cSCC, SNB is a safe and feasible staging technique. The total number of high risk features and certain combinations of high-risk features predicted metastasis better than individual high-risk features.
BACKGROUND: Regional nodal metastases from cutaneous squamous cell carcinoma (cSCC) is strongly associated with a poor prognosis, but these metastases are difficult to predict clinically. Sentinel node biopsy (SNB) has been used for a wide range of malignancies to assess for regional nodal metastasis, but is not widely used for cSCC. METHODS:Patients presenting with high-risk cSCC of the head and neck with clinically N0 necks were offered SNB at the time of primary cSCC excision or secondary wide local excision. Patients with positive sentinel nodes were offered completion lymph node dissection, and all the patients were followed up at regular intervals for up to 5 years. RESULTS: In this study, 105 lesions underwent SNB, and 10 sentinel nodes (9.5%) were positive. In an additional five patients, regional recurrence developed after a negative sentinel node, with a total subclinical nodal metastasis rate of 14.3%. Nodal metastases were significantly associated with reduced disease-specific survival. The significant predictors of metastasis were four or more high-risk features or tumors with a concurrent invasion deeper than 5 mm and PNI. CONCLUSION: For high-risk cSCC, SNB is a safe and feasible staging technique. The total number of high risk features and certain combinations of high-risk features predicted metastasis better than individual high-risk features.
Authors: Patrick L Quinn; Jin K Kim; Vishnu Prasath; Neal Panse; Thomas J Knackstedt; Ravi J Chokshi Journal: Arch Dermatol Res Date: 2022-03-18 Impact factor: 3.017