Pattern of Lymph Node Metastasis of Cutaneous Malignancies Involving the Temporal Bone

Presentation: AHNS46
Topic: Skin Cancer
Type: Oral
Date: Thursday, April 28, 2022
Session: 1:00 PM – 1:30 PM Potpourri
Authors: Justin M Hintze, MD; Holly Jones, MD; Adrien Gendre, MD; Rory McConn Walsh, MD; Neville Shine, MD; James Paul O'Neill, MD
Institution(s): Beaumont Hospital, Dublin, Ireland


Objective:

The objective of the present study was to explore the pattern of lymph node spread malignancies involving the lateral temporal bone, as well as determine the rate of spread to the parotid gland. 

Methods: We retrospectively reviewed all lateral temporal bone resections for malignancies involving the lateral temporal bone over a 20-year time period. 39 patients were available for final analysis. Type of neck dissection performed and adjunctive procedures such as parotidectomy and pinnectomy performed were recorded. 

Results: Mean age was 70.68 ± 12 years. The most common histological diagnosis was SCC in 84.2% (n=32).

All patients underwent a LTBR, while 68.4% (n=26) underwent a pinnectomy, 71.1% (n=27) had a parotidectomy and 65.8% (n=25) had a neck dissection (44% of which were modified radical). 

Level 1 was positive in 2.6%, level 2 in 15.8%, level 3 in 7.9%, level 4 in 7.9% and level 5 in 5.3%. The parotid had disease in 34.2% (n=13), of which 54% was due to direct invasion. 59% of patients underwent free flap reconstruction. Pathological size of the main specimen did not influence the rate of nodal disease, however depth of the specimen did (p=0.117 and 0.009 respectively). 

Mean overall survival of the cohort was 4 years, while mean disease specific survival was 5.3 years. There was no statistical significant difference in survival based on nodal disease or parotid disease.

Conclusions: In the present study the rate of cervical nodal metastasis was 21%, with the most common location for nodal metastasis in level 2. The parotid was involved in in 34% of cases. Due to the high rate of parotid disease, results from the present support consideration for performing a parotidectomy at the time of lateral temporal bone resection, while a neck dissection can be performed for adequate staging of the nodal basin as well as during dissection of vessels for microvascular reconstruction.