title: Direct skin involvement of cervical lymph node metastasis from mucosal squamous cell carcinoma of the head and neck.
abstract: BACKGROUND
  Direct skin involvement of nodal metastasis from mucosal head and neck squamous cell carcinoma has traditionally been considered a poor prognostic indicator.
  
  
  METHODS
  This retrospective review identified eight patients (five with mucosal upper aerodigestive and three with occult primary squamous cell carcinoma) who presented between 2000 and 2007 with direct skin involvement of nodal metastasis.
  
  
  RESULTS
  Five patients were treated with extended radical and three with extended modified radical neck dissection. Closure was achieved directly (four cases), with local (two) or pedicled (two) flaps. Surgery was always followed by radiotherapy (pan-mucosal or to the primary site). The five-year recurrence-free and disease-specific survival rates were 100 per cent.
  
  
  CONCLUSIONS
  It is exceptionally rare to encounter direct skin involvement of metastatic lymph nodes from mucosal head and neck squamous cell carcinoma without evidence of involvement of other anatomical structures. Surgical intervention is possible and combined modality treatment with curative intent is essential, as most patients can have a favourable outcome.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Dragan
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.
authors.forename: I J
authors.initials: IJ
authors.lastname: Nixon
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.
authors.forename: A A
authors.initials: AA
authors.lastname: Orabi
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Manganaris
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.
authors.forename: J-P
authors.initials: JP
authors.lastname: Jeannon
authors.affiliation: Department of Clinical and Radiation Oncology, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.
authors.forename: M T
authors.initials: MT
authors.lastname: Guerrero-Urbano
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Simo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology*; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D000077195:Squamous Cell Carcinoma of Head and Neck