Onkológia 4/2023

Cutaneous squamous cell carcinoma of the head and neck metastatic to regional lymph nodes

Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer and its incidence is rising. The majority of patients with cSCC have favorable prognosis with the cure rate of greater than 90% but patients with high-risk cSCC have greater risk of metastasis. Cutaneous squamous cell carcinoma of the head and neck (cHNSCC) may metastasize in up to 5% of patients, with the parotid lymph node the most frequent site for spread. Predicting the risk of developing lymph node metastases from cSCC is difficult, although several unfavorable features of primary lesions increase of patient’s risk. The optimum treatment for regional metastatic cHNSCC should be surgical resection with adjuvant radiotherapy. The extent of surgery needs to be tailored to the extent of disease and location of the primary lesions. If there is a clinical suspicion of involvement of regional nodes, a therapeutic lymphadenectomy (parotidectomy and/or neck dissection) should be performed. Elective parotidectomy and/or neck dissection in clinically negative regional lymph nodes is usually not advised and also elective parotidectomy is not advocated for patients with isolated neck disease. In patients with parotid metastasis of cHNSCC and clinically negative neck, parotidectomy with elective selective neck dissection with extent according to primary tumor location, should be performed. Although sentinel lymph node biopsy in cHNSCC patients is an accurate staging tool of clinically negative neck, there are no data available on the prognostic or the therapeutic value.

Keywords: cutaneous head and neck squamous cell carcinoma, regional lymph node metastasis, parotidectomy, neck dissection, radiotherapy, sentinel lymph node biopsy