Elective Neck Dissection for Head and Neck Cutaneous Squamous Cell Carcinoma with Skull Base Invasion. (28th February 2017)

• Record Type: Journal Article
• Authors: Cannon, Richard B.; Dundar, Yusuf; Thomas, Andrew; Monroe, Marcus M.; Buchmann, Luke O.; Witt, Benjamin L.; Sowder, Aleksandra M.; Hunt, Jason P.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 156:Number 4(2017)
• Page Start: 671
• Page End: 676
• Publication Date: 2017-02-28
• Subjects: cutaneous squamous cell carcinoma -- skin cancer -- head and neck -- skull base invasion -- elective neck dissection -- perineural spread -- risk factors -- survival outcomes; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599817691923
• Languages: English
• ISSNs: 0194-5998

Abstract

Abstract : Objectives: Skull base invasion from cutaneous squamous cell carcinoma (cSCC) via perineural spread affects survival and the rate of regional metastasis. Our objective is to investigate the factors associated with elective neck dissection (END) in this population and the survival difference with END compared with observation for patients with a cN0 neck. Study Design: Case series with chart review. Setting: Academic. Subjects and Methods: Patients were treated surgically for head and neck cSCC with skull base invasion via perineural spread with a cN0 neck from 2004 to 2014. Clinicopathologic data were collected and analyzed. Primary outcomes were disease‐free survival (DFS) and overall survival (OS). Results: Fifty‐nine patients met inclusion criteria: 28 underwent an END and 31 underwent neck observation. Free tissue transfer reconstruction was significantly associated with END ( P <. 001). Patients treated with an END had significantly improved 5‐year DFS (57% and 32%, P =. 042) and OS (60% and 37%, P =. 036) compared with those who were observed and a significantly reduced rate of regional recurrence (9% and 37%, P =. 024). The rate of occult nodal metastasis identified with END was 36% and is approximately equal to the regional failure rate of the neck observation group (37%). Conclusion: END was more commonly used in cases requiring free tissue transfer. The use of END for head and neck cSCCs that have invaded the skull base is not routinely performed but was found to be associated with a survival advantage and reduced regional recurrence rate.