Regional lymph node metastasis is an important prognostic factor in squamous cell carcinoma of the head and neck, decreasing survival by up to 50%. The impact of index lesion location and patterns of regional spread of cutaneous head and neck squamous cell carcinoma (cuHNSCC) are yet to be defined.
Retrospective analysis of patients treated at MD Anderson Cancer Center between 1991 and 2017.
SUBJECTS AND METHODS:
Patients with diagnosis of cuHNSCC treated with curative intent were included. Resulting data including patient demographics, clinicopathological features, neck level distribution of nodal metastasis, and survival based on lymph node level involvement were analyzed.
In total, 361 patients were identified with cuHNSCC who underwent neck dissection. Level II (18.8%), followed by levels III (8.8%), I (6.1%) and V (5.2%), represented the most commonly involved nodal basins. The most common primary tumor sites metastasized to levels I, II III, IV and V were lower face 12/20 (60.0%), periauricular 37/68 (54.4%) and 19/32 (59.3%), neck 5/17 (29.4%) and upper face and scalp 8/19 (42.11%), respectively. Contralateral nodes were present in 7/361 (1.9%) patients. The 5-year disease-specific survival (DSS) for patients with periauricular, midface, lower face and neck or upper face and scalp was 66%, 58%, 56% and 55% (P = .285). Neck dissection with adjuvant neck radiotherapy did not change significantly the 5-year DSS or regional recurrence compared with surgery alone, regardless of the primary tumor location.
Index tumor location is a significant determinant of regional spread. The role of multimodality approach for nodal disease in cuHNSCC should be evaluated in clinical trials.