[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Views 820
Citations 0
Original Investigation
From the American Head and Neck Society
December 2016

Sentinel Lymph Node Biopsy for Cutaneous Squamous Cell Carcinoma on the Head and Neck

Author Affiliations
  • 1Department of Dermatology, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor
  • 2Department of Pathology, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor
  • 3Department of Otolaryngology, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor
  • 4Division of Plastic Surgery, Department of Surgery, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor
JAMA Otolaryngol Head Neck Surg. 2016;142(12):1171-1176. doi:10.1001/jamaoto.2016.1927
Key Points

Question  Should patients with cutaneous squamous cell carcinoma (SCC) on the head and neck be considered for staging with sentinel lymph node biopsy (SLNB)?

Findings  In this retrospective review of 53 patients, nodal metastasis was identified in 15.1% by SLNB and the rate of false omission was 7.1%. The importance of histologic processing of SLNB specimens was demonstrated.

Meaning  Our findings indicate that there may be a role for SLNB in the treatment of SCC on the head and neck for patients at high risk of nodal metastasis as defined by the National Comprehensive Cancer Network guidelines.


Importance  Metastasis of cutaneous squamous cell carcinoma (SCC) to the nodal basin is associated with a poor prognosis. The role of sentinel lymph node biopsy (SLNB) for regional staging in patients diagnosed with SCC is unclear.

Objective  To evaluate a single institution’s experience with use of SLNB for regional staging of SCC on the head and neck.

Design, Setting, and Participants  A retrospective review of 53 patients who were diagnosed with SCC on the head and neck, at high risk for nodal metastasis based on National Comprehensive Cancer Network (NCCN) risk factors, and treated with wide local excision (WLE) and SLNB from December 1, 2010, through January 30, 2015, in a single academic referral center was performed. The follow-up period ended November 5, 2015. Sentinel lymph node biopsy paraffin blocks were retrieved and processed retrospectively with serial sectioning and immunohistochemical analysis (IHC) in cases with nodal recurrence following a negative SLNB.

Main Outcomes and Measures  Sentinel node (SN) identification rate, SLNB positivity rate, local recurrence, regional nodal recurrence, and distant recurrence.

Results  In 53 patients with 54 tumors the SN identification rate was 94%. The SLNB positivity rate was 11.3%. On more thorough tissue processing and IHC, metastatic SCC was identified in 2 of 5 (40%) cases previously deemed negative. After reclassification of these cases, the adjusted SLNB positivity rate was 15.1%. The adjusted rate of false omission was 7.1% (95% CI, 2%-19%). Nodal disease developed in 20.8% overall. Angiolymphatic invasion (Cohen d, 3.52; 95% CI, 1.83-5.21), perineural invasion (Cohen d, 0.81; 95% CI, 0.09-1.52), and clinical size (Cohen d, 0.83; 95% CI, 0.05-1.63) were associated with the presence of nodal disease.

Conclusions and Relevance  Rigorous study of SLNB for cutaneous SCC incorporating prospectively-collected comprehensive data sets based on standardized treatment algorithms is justified with potential to modify clinical practice. Our study demonstrates the critical importance of serial sectioning and IHC of the SLNB specimen for accurate diagnosis. Use of the NCCN guidelines may facilitate identification of patients with SCC at high risk for nodal metastasis.