title: Lymph node metastases from cutaneous squamous cell carcinoma of the head and neck.
abstract: OBJECTIVE
  Cutaneous squamous cell carcinoma (CSCC) has been reported to metastasize to parotid and cervical lymph nodes. Few prospective investigations of associated clinical and histopathologic findings and their effect on patient outcomes exist. We seek to identify risk factors for nodal metastases in CSCC and determine the impact of lymphatic spread on survival and recurrence.
  
  
  METHODS
  Subset analysis of a prospective, longitudinal database of patients with CSCC at a comprehensive cancer center.
  
  
  METHODS
  Eligible patients with nonmelanoma skin cancer were consecutively enrolled in a prospective database from July 1996 through June 2001; this cohort was then followed to the key endpoints of recurrence and mortality.
  
  
  RESULTS
  Two hundred ten patients were enrolled, and 193 patients with CSCC of the head and neck are included in this analysis. The incidence of nodal metastases in this population was 20.7% at study entry. Median follow-up was 20 months in patients with lymph node metastases and 24 months in patients without metastases. Nodal metastases were significantly associated with recurrent lesions (P = .002) and the following histopathologic features: lymphovascular invasion (P < .0001), inflammation (P = .010), poorly differentiated histology (P = .001), invasion into the subcutaneous tissues (P = .0001), perineural invasion (P = .005), and larger size (P = .0007). Metastases to the cervical nodes were not clinically apparent in 42% of patients with parotid metastases. Combination surgery and radiation therapy resulted in regional control rates of 95%, although local recurrence and distant metastases, along with second primary tumors, were the most frequent recurrent events. Kaplan-Meier survival analysis demonstrates a decrease in overall survival (P = .005), disease-free survival (P = .015), disease-specific survival (P = 0002), and time to recurrence (P = .012) in patients with nodal metastases compared with controls.
  
  
  CONCLUSIONS
  Lymph node metastases from CSCC are common in our population and are associated with diminished survival. The presence of nodal spread occurs with other adverse histopathologic findings, and we recommend surgery and postoperative radiation therapy to control regional disease in the presence of nodal metastases and perineural invasion. New approaches in early identification of nodal metastases, treatment, and prevention of local recurrences and second primary malignancies are warranted.
authors.affiliation: Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Moore
authors.forename: Randal S
authors.initials: RS
authors.lastname: Weber
authors.forename: Victor
authors.initials: V
authors.lastname: Prieto
authors.forename: Adel
authors.initials: A
authors.lastname: El-Naggar
authors.forename: F Christopher
authors.initials: FC
authors.lastname: Holsinger
authors.forename: Xian
authors.initials: X
authors.lastname: Zhou
authors.forename: J Jack
authors.initials: JJ
authors.lastname: Lee
authors.forename: Scott
authors.initials: S
authors.lastname: Lippman
authors.forename: Gary L
authors.initials: GL
authors.lastname: Clayman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D006801:Humans; D007249:Inflammation / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local; D010307:Parotid Neoplasms / Q000556:secondary; D011446:Prospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology*; D015996:Survival Rate