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Original Article
May 1998

Regional Lymph Node Metastasis From Cutaneous Squamous Cell Carcinoma

Author Affiliations

From the Head and Neck Service, Departments of Surgery (Drs Kraus and Carew) and Brachytherapy Service, Department of Radiation Oncology (Dr Harrison), Memorial Sloan-Kettering Cancer Center, New York, NY.

Arch Otolaryngol Head Neck Surg. 1998;124(5):582-587. doi:10.1001/archotol.124.5.582

Objective  To characterize clinical presentation and prognostic factors in patients with histologically proven regional lymph node metastasis from cutaneous squamous cell carcinoma of head and neck origin.

Design  Retrospective, nonrandomized case series.

Setting  Tertiary referral center.

Patients  Forty-five patients treated between 1984 and 1995 with regional metastatic squamous cell carcinoma of cutaneous head and neck origin.

Intervention  Forty-one patients underwent neck dissection (20 with parotidectomy) and 4 patients underwent parotidectomy alone. Thirty-six patients (80%) received postoperative radiation therapy with a mean dose of 60 Gy (range, 34-71 Gy).

Main Outcome Measures  Recurrences and survival by univariate analysis using the Kaplan-Meier product-limit method. The log-rank test was used to evaluate prognostic significance of clinical variables.

Results  Follow-up ranged from 2 months to 10 years (mean, 21 months). Compared with historical controls, a greater percentage of patients in our population with regional lymph node metastasis had primary lesions greater than 2 cm in diameter and 4 mm deep. Overall 2- and 5-year survival rates were 33% and 22%, respectively, while 5-year disease-free survival rate was 34%. Clinical staging of the neck proved to be the only factor of prognostic value (P<.01). Treatment failures occurred in 22 patients.

Conclusions  For the small subset of patients with regional metastasis from cutaneous squamous cell carcinoma, survival remains poor despite multimodality treatment. Clinical stage of the neck was the only factor that predicted outcome.