title: Isolated skip nodal metastasis is rare in T1 and T2 oral tongue squamous cell carcinoma.
abstract: OBJECTIVE
  Nodal metastasis from oral tongue squamous cell carcinoma follows a predictable pattern. Isolated level IV involvement, termed skip metastases, is described. This study attempts to identify the incidence of skip metastasis.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary academic hospital.
  
  
  METHODS
  Fifty-two consecutive patients with T1 to T4 N0 stage who underwent excision of the primary tumor with neck dissection (levels I-IV).
  
  
  METHODS
  Retrospective study. The incidence of isolated level III or IV involvement pathologically and isolated nodal recurrence in levels III and IV was analyzed.
  
  
  RESULTS
  Pathologically, isolated level III involvement occurred in 2 (3.8%) patients. Isolated level IV occurred in 1 (1.9%) patient. Mean follow-up was 24 months. Two patients had recurrence in the primary site; 1 had recurrence in neck level II. None had recurrence in level III or IV.
  
  
  CONCLUSIONS
  Skip metastasis is rare in T1 and T2 oral tongue squamous cell carcinoma. Inclusion of level IV is not mandatory in selective neck dissection for clinically and radiologically negative neck disease in early tumors (T1 and T2).
authors.affiliation: Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Balasubramanian
authors.forename: Krishnakumar
authors.initials: K
authors.lastname: Thankappan
authors.forename: Azhar Jan
authors.initials: AJ
authors.lastname: Battoo
authors.forename: Mayuri
authors.initials: M
authors.lastname: Rajapurkar
authors.forename: Moni Abraham
authors.initials: MA
authors.lastname: Kuriakose
authors.forename: Subramania
authors.initials: S
authors.lastname: Iyer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000556:secondary*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D014062:Tongue Neoplasms / Q000473:pathology*