title: Elective Neck Dissection for Head and Neck Cutaneous Squamous Cell Carcinoma with Skull Base Invasion.
abstract: Objectives Skull base invasion from cutaneous squamous cell carcinoma (cSCC) via perineural spread affects survival and the rate of regional metastasis. Our objective is to investigate the factors associated with elective neck dissection (END) in this population and the survival difference with END compared with observation for patients with a cN0 neck. Study Design Case series with chart review. Setting Academic. Subjects and Methods Patients were treated surgically for head and neck cSCC with skull base invasion via perineural spread with a cN0 neck from 2004 to 2014. Clinicopathologic data were collected and analyzed. Primary outcomes were disease-free survival (DFS) and overall survival (OS). Results Fifty-nine patients met inclusion criteria: 28 underwent an END and 31 underwent neck observation. Free tissue transfer reconstruction was significantly associated with END ( P < .001). Patients treated with an END had significantly improved 5-year DFS (57% and 32%, P = .042) and OS (60% and 37%, P = .036) compared with those who were observed and a significantly reduced rate of regional recurrence (9% and 37%, P = .024). The rate of occult nodal metastasis identified with END was 36% and is approximately equal to the regional failure rate of the neck observation group (37%). Conclusion END was more commonly used in cases requiring free tissue transfer. The use of END for head and neck cSCCs that have invaded the skull base is not routinely performed but was found to be associated with a survival advantage and reduced regional recurrence rate.
authors.affiliation: 1 The University of Utah School of Medicine, Otolaryngology Head and Neck Surgery, Salt Lake City, Utah, USA.|2 Huntsman Cancer Hospital, Salt Lake City, Utah, USA.|3 George E. Whalen VAMC, Department of Surgery, Division Otolaryngology, Salt Lake City, Utah, USA.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Cannon
authors.affiliation: 1 The University of Utah School of Medicine, Otolaryngology Head and Neck Surgery, Salt Lake City, Utah, USA.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Dundar
authors.affiliation: 1 The University of Utah School of Medicine, Otolaryngology Head and Neck Surgery, Salt Lake City, Utah, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Thomas
authors.affiliation: 1 The University of Utah School of Medicine, Otolaryngology Head and Neck Surgery, Salt Lake City, Utah, USA.|2 Huntsman Cancer Hospital, Salt Lake City, Utah, USA.|3 George E. Whalen VAMC, Department of Surgery, Division Otolaryngology, Salt Lake City, Utah, USA.
authors.forename: Marcus M
authors.initials: MM
authors.lastname: Monroe
authors.affiliation: 1 The University of Utah School of Medicine, Otolaryngology Head and Neck Surgery, Salt Lake City, Utah, USA.|2 Huntsman Cancer Hospital, Salt Lake City, Utah, USA.|3 George E. Whalen VAMC, Department of Surgery, Division Otolaryngology, Salt Lake City, Utah, USA.
authors.forename: Luke O
authors.initials: LO
authors.lastname: Buchmann
authors.affiliation: 4 The University of Utah School of Medicine, Department of Pathology, Salt Lake City, Utah, USA.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Witt
authors.affiliation: 4 The University of Utah School of Medicine, Department of Pathology, Salt Lake City, Utah, USA.
authors.forename: Aleksandra M
authors.initials: AM
authors.lastname: Sowder
authors.affiliation: 1 The University of Utah School of Medicine, Otolaryngology Head and Neck Surgery, Salt Lake City, Utah, USA.|2 Huntsman Cancer Hospital, Salt Lake City, Utah, USA.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Hunt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D009361:Neoplasm Invasiveness; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D019291:Skull Base; D000077195:Squamous Cell Carcinoma of Head and Neck; D016019:Survival Analysis
keywords: cutaneous squamous cell carcinoma; elective neck dissection; head and neck; perineural spread; risk factors; skin cancer; skull base invasion; survival outcomes