title: Axillary nodal metastasis at primary presentation of an oropharyngeal primary carcinoma: a case report and review of the literature.
abstract: BACKGROUND
  Axillary nodal metastasis is very rare in head and neck squamous cell carcinoma. The few cases reported in the literature all involve patients who have previously undergone either neck dissection alone, or neck dissection and radiotherapy to the neck, and subsequently develop delayed recurrences of disease, with axillary nodal involvement.
  
  
  METHODS
  We present the case of a 62-year-old man of Cape Malay ethnicity, who presented with an oropharyngeal squamous cell carcinoma, and cervical and axillary nodal metastasis at primary presentation.
  
  
  CONCLUSIONS
  Whilst previous reports in the literature suggest routine examination of the axilla is advisable in patients with previously treated neck cancer and recurrence of head and neck cancer, we propose that the axilla should be routinely examined in new cases, particularly when there is involvement of the level 5 nodes.
authors.affiliation: Department of Otorhinolaryngology, Faculty of Health Science, University of Stellenbosch Tygerberg, 7505 South Africa.
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: McKenzie
authors.forename: James W
authors.initials: JW
authors.lastname: Loock