title: Management of the neck in metastatic cutaneous squamous cell carcinoma of the head and neck.
abstract: OBJECTIVE
  This article reviews the predictors, prognosis, and treatment of nodal metastases in cutaneous squamous cell carcinoma of the head and neck.
  
  
  RESULTS
  There is a better understanding of the risk factors that predict metastatic disease in cutaneous squamous cell carcinoma. Recent data has simplified the relationship between the site of the primary tumour and nodal disease, allowing for a more selective approach to the neck, in terms of both surgery and radiotherapy. Newer staging systems that take into account the clinicopathological factors allow better prognostication, and their application has been discussed. There is ongoing research on concurrent chemoradiotherapy, sentinel node biopsy, and epidermal growth factor receptor overexpression.
  
  
  CONCLUSIONS
  The status of the parotid and level II/III nodes has important implications for the management of the neck, and therefore dissection of level I and level IV/V nodes is required in selected cases only. Prognostic stratification is needed to tailor treatment algorithms that intensify therapy in high-risk disease and minimize toxicity in selected low-risk patients.
authors.affiliation: Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: Jacob
authors.initials: J
authors.lastname: D'Souza
authors.forename: Jonathan
authors.initials: J
authors.lastname: Clark
mesh_terms: D000465:Algorithms; D014408:Biomarkers, Tumor / Q000032:analysis / Q000235:genetics; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D066246:ErbB Receptors / Q000032:analysis / Q000235:genetics; D006801:Humans; D037981:Neck Dissection; D009362:Neoplasm Metastasis / Q000473:pathology*; D009367:Neoplasm Staging; D010039:Otorhinolaryngologic Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D010306:Parotid Gland / Q000473:pathology / Q000601:surgery; D010307:Parotid Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*
chemical_list: D014408:Biomarkers, Tumor; C512478:EGFR protein, human; D066246:ErbB Receptors