title: Utility of head and neck cutaneous squamous cell carcinoma sentinel node biopsy: a systematic review.
abstract: OBJECTIVE
  Sentinel lymph node biopsy (SLNB) is standard of care for melanoma, but its role in cutaneous squamous cell carcinoma (cSCC) has not been established. Study objectives include: (1) analyze the feasibility and reliability SLNB for head and neck (H&N) cSCC and (2) identify risk factors associated with a positive SLN.
  
  
  METHODS
  MEDLINE, PubMed, Cochrane, and ASCO databases searches conducted (1946-2013).
  
  
  METHODS
  Using the PRISM model, a comprehensive systematic review of H&N cSCC SLNB studies with associated recurrence rates was conducted. Dual-blinded data extraction identify primary outcomes (successful SLN harvest and false omission rate) and secondary outcomes (risk factors associated with a +SLN).
  
  
  RESULTS
  Two hundred twenty-one articles were screened; 73 patients from 11 publications met inclusion criteria (3 case series; 8 prospective cohorts). Studies ranged from 1 to 15 patients (median 5). Median age was 74 years. Median follow-up was 21.5 months. Average tumor size was 3.09 cm. At least 1 SLN was identified in 100% of patients (median 2). Ten (13.5%) had a positive SLN; no additional metastatic nodes were identified in 9 patients receiving completion lymphadenectomy. Tumor diameter was not associated with SLN status (P = .09; 95% CI, -.27 to 3.02). Risk factors (tumor depth, perineural invasion, location, differentiation) were not consistently recorded. Three of 63 (4.76%) failed regionally following a negative SLNB.
  
  
  CONCLUSIONS
  H&N cSCC SLNB is feasible and reliable for staging, with a false omission rate of 4.7% mirroring melanoma. Prospective studies documenting high risk features are required to further define its role.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA.
authors.forename: Mostafa M
authors.initials: MM
authors.lastname: Ahmed
authors.forename: Brian A
authors.initials: BA
authors.lastname: Moore
authors.forename: Cecelia E
authors.initials: CE
authors.lastname: Schmalbach
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology* / Q000532:radiotherapy; D005240:Feasibility Studies; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000532:radiotherapy; D006801:Humans; D008197:Lymph Node Excision; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D018714:Radiotherapy, Adjuvant; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods / Q000592:standards; D012878:Skin Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000532:radiotherapy; D000077195:Squamous Cell Carcinoma of Head and Neck
keywords: cutaneous squamous cell carcinoma; sentinel node; skin cancer