High‐Risk Cutaneous Squamous Cell Carcinoma without Palpable Lymphadenopathy: Is There a Therapeutic Role for Elective Neck Dissection?

• Published in: Dermatologic surgery 2007-04, Vol.33 (4), p.410-420
• Main Authors: MARTINEZ, JUAN‐CARLOS, COOK, JONATHAN L.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Carcinoma, Squamous Cell - secondary; Carcinoma, Squamous Cell - surgery; Dermatology; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - surgery; Humans; Lymphatic Metastasis; Medical sciences; Neck Dissection; Sentinel Lymph Node Biopsy; Skin plastic surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tumors of the skin and soft tissue. Premalignant lesions
• ISSN: 1076-0512; 1524-4725
• DOI: 10.1111/j.1524-4725.2007.33087.x

PURPOSE The beneficial role of elective neck dissection (END) in the management of high‐risk cutaneous squamous cell carcinoma (CSCC) of the head and neck remains unproven. Some surgical specialists suggest that END may be beneficial for patients with clinically node‐negative (N0) high‐risk CSCC, but there are few data to support this claim. We reviewed the available literature regarding the use of END in the management of both CSCC and head and neck SCC (HNSCC). METHODOLOGY The available medical literature pertaining to END in both CSCC and HNSCC was reviewed using PubMed and Ovid Medline searches. RESULTS Many surgical specialists recommend that END be routinely performed in patients with N0 HNSCC when the risk of occult metastases is estimated to exceed 20%; however, patients who undergo END have no proven survival benefit over those who are initially staged as N0 and undergo therapeutic neck dissection (TND) after the development of apparent regional disease. There is a lack of data regarding the proper management of regional nodal basins in patients with N0 CSCC. In the absence of evidence‐based data, the cutaneous surgeon must rely on clinical judgment to guide the management of patients with N0 high‐risk CSCC of the head and neck. CONCLUSIONS Appropriate work‐up for occult nodal disease may occasionally be warranted in patients with high‐risk CSCC. END may play a role in only a very limited number of patients with high‐risk CSCC.