title: Prediction score for lymph node metastasis from cutaneous squamous cell carcinoma of the external ear.
abstract: OBJECTIVE
  The frequency of lymph node metastasis (LNM) is higher in cutaneous squamous cell carcinoma (cSCC) of the ear than in other head and neck cSCCs. Nodal dissemination is associated with a significantly worse prognosis and disease-specific survival. The aim of this study was to establish a prediction model for LNM in patients with cSCC of the ear.
  
  
  METHODS
  Tumour characteristics of 353 patients with ear cSCC were analysed to assess differences between those with and without LNM and to calculate a prediction score for LNM occurrence.
  
  
  RESULTS
  Regional LNM occurred in 10.5% of patients. Five-year disease-specific survival was significantly lower in the LNM group than in the control group (59% vs. 99%; p < 0.001). Recurrence number, invasion of cartilage, tumour depth, and tumour grading were the most important predictors for LNM, with correct prediction of LNM in 94.0% of cases. Our prediction score stratified patients into high and low risk groups (p < 0.001) with a sensitivity of 89.2%, a specificity of 94.6%, and an overall accuracy of 94.1%.
  
  
  CONCLUSIONS
  Our new prediction model was able to accurately identify patients at high risk of LNM who may benefit from elective lymph node surgery.
authors.affiliation: Fachklinik Hornheide, Skin Cancer Centre, Department of Cranio-Maxillofacial Surgery, Muenster, Germany. Electronic address: Kai.Wermker@fachklinik-hornheide.de.
authors.forename: K
authors.initials: K
authors.lastname: Wermker
authors.affiliation: Fachklinik Hornheide, Skin Cancer Centre, Department of Cranio-Maxillofacial Surgery, Muenster, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Kluwig
authors.affiliation: Fachklinik Hornheide, Skin Cancer Centre, Department of Cranio-Maxillofacial Surgery, Muenster, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Schipmann
authors.affiliation: Fachklinik Hornheide, Skin Cancer Centre, Department of Cranio-Maxillofacial Surgery, Muenster, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Klein
authors.affiliation: Fachklinik Hornheide, Skin Cancer Centre, Department of Dermatology and Dermato-Histo-Pathology, Muenster, Germany.
authors.forename: H J
authors.initials: HJ
authors.lastname: Schulze
authors.affiliation: Fachklinik Hornheide, Skin Cancer Centre, Department of Dermatology and Dermato-Histo-Pathology, Muenster, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Hallermann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D018572:Disease-Free Survival; D004425:Ear Cartilage / Q000473:pathology; D004428:Ear Neoplasms / Q000473:pathology*; D004431:Ear, External / Q000473:pathology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000473:pathology*; D000077195:Squamous Cell Carcinoma of Head and Neck
keywords: Ear neoplasms; Lymph node excision; Lymphatic metastasis; Prognosis; Squamous cell carcinoma