title: Outcomes of nodal metastatic cutaneous squamous cell carcinoma of the head and neck treated in a regional center.
abstract: BACKGROUND
  Given its metastatic potential and high incidence, cutaneous squamous cell carcinoma of the head and neck (SCCHN) has significant morbidity and mortality.
  
  
  METHODS
  We conducted a retrospective review of prospectively collected data for 113 consecutive patients with nodal metastatic cutaneous SCCHN treated surgically with curative intent in a regional center. Survival curves were generated by the Kaplan-Meier method.
  
  
  RESULTS
  Five-year overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were 80%, 83%, and 75%, respectively. Twenty-six patients (23%) relapsed, with 92% of relapses occurring within 2 years of surgery. Immunosuppression (p = .008) and N classification (p = .043) predicted decreased DFS on univariate analysis. On multivariate analysis, only immunosuppression independently predicted DFS (p = .034).
  
  
  CONCLUSIONS
  This study validates the current N classification system, supports the adverse effect of immunosuppression, and suggests that intense follow-up for 2 years postsurgery is warranted. Survival at this regional center is comparable to that achieved at metropolitan tertiary cancer centers.
authors.affiliation: School of Medicine, University of Queensland, Queensland, Australia.
authors.forename: Campbell
authors.initials: C
authors.lastname: Schmidt
authors.affiliation: Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, Australia.
authors.forename: Jarad M
authors.initials: JM
authors.lastname: Martin
authors.affiliation: Radiation Oncology Queensland, St Andrew's Cancer Care Center, St Andrew's Hospital, Toowoomba, Queensland, Australia.
authors.forename: Eric
authors.initials: E
authors.lastname: Khoo
authors.affiliation: Oncology Research Australia, Australia.
authors.forename: Ashley
authors.initials: A
authors.lastname: Plank
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Toowoomba Rural Clinical School, University of Queensland, Queensland, Australia.
authors.forename: Roger
authors.initials: R
authors.lastname: Grigg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology* / Q000556:secondary / Q000601:surgery*; D006801:Humans; D016867:Immunocompromised Host; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D000077195:Squamous Cell Carcinoma of Head and Neck; D016896:Treatment Outcome
keywords: carcinoma; head and neck neoplasms; lymphatic metastasis; rural health services; squamous cell; survival analysis