title: Head and neck cutaneous squamous cell carcinoma metastatic to cervical sublevel IIb lymph nodes occurred from primary sites involving the auricle and adjacent neck.
abstract: OBJECTIVE
  Neck dissections that include sublevel IIb increase the risk of postoperative shoulder dysfunction. The purpose of this investigation was to document the incidence of level IIb metastatic lymphatic spread in a group of patients undergoing neck dissection as part of the surgical management of cutaneous squamous cell carcinoma of the head and neck.
  
  
  METHODS
  A retrospective review of the pathology records taken from 1 surgeon from June 2006 through June 2013 was carried out. The predictor variable was the primary tumor site. The outcome variable was the metastatic nodal involvement according to neck level and sublevel. Secondary variables included T stage, pathologist, tumor depth, and the presence of perineural, perilymphatic, and perivascular invasion. Data analyses were by descriptive statistics.
  
  
  RESULTS
  Thirty-six patients with a total of 40 neck dissections met the inclusion criteria. The average primary site tumor depth was 14.7 mm, and there were 16 cases of poorly differentiated squamous cell carcinoma. Sublevel IIb was involved in 7.5% of cases, all of which occurred from lateralized primary sites of the head and neck.
  
  
  CONCLUSIONS
  Cutaneous squamous cell carcinoma arising from the auricle and neck sites adjacent to sublevel IIb may have increased risk of metastatic involvement of sublevel IIb nodes. Further studies with larger numbers are required to determine the risk of metastasis to sublevel IIb from midline sites of the face.
authors.affiliation: Resident Medical Officer, Hunter New England Health, New South Wales, Australia. Electronic address: deutscheng@hotmail.com.
authors.forename: Nigel Gordon
authors.initials: NG
authors.lastname: Maher
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Gary Russell
authors.initials: GR
authors.lastname: Hoffman
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000556:secondary*; D016009:Chi-Square Distribution; D002680:Chin / Q000473:pathology; D004428:Ear Neoplasms / Q000473:pathology / Q000556:secondary*; D004431:Ear, External / Q000473:pathology*; D005153:Facial Neoplasms / Q000556:secondary*; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000556:secondary*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D009333:Neck; D037981:Neck Dissection / Q000706:statistics & numerical data; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009669:Nose Neoplasms / Q000556:secondary; D009918:Orbital Neoplasms / Q000556:secondary; D012189:Retrospective Studies