BioMed Research International

BioMed Research International / 2007 / Article

Review Article | Open Access

Volume 2007 |Article ID 80572 | 6 pages | https://doi.org/10.1155/2007/80572

High-Risk Cutaneous Squamous Cell Carcinoma of the Head and Neck

Academic Editor: Honnavara N. Ananthaswamy
Received21 Nov 2006
Revised20 Jan 2007
Accepted14 Feb 2007
Published03 Apr 2007

Abstract

Nonmelanoma skin cancers (squamous cell and basal cell carcinomas) occur at an epidemic rate in many countries with the worldwide incidence increasing. The sun-exposed head and neck are the most frequent sites for these cancers to arise and in most patients diagnosed with a cutaneous squamous cell carcinoma, local treatment is usually curative. However, a subset is diagnosed with a high-risk cutaneous squamous cell carcinoma. High-risk factors include size (> 2 cm), thickness/depth of invasion (> 4 mm), recurrent lesions, the presence of perineural invasion, location near the parotid gland, and immunosuppression. These patients have a higher risk (> 10–20%) of developing metastases to regional lymph nodes (often parotid nodes), and in some cases also of experiencing local morbidity (perineural invasion), based on unfavourable primary lesion and patient factors. Despite treatment, many patients developing metastatic cutaneous squamous cell carcinoma experience mortality and morbidity usually as a consequence of uncontrolled metastatic nodal disease. It is therefore important that clinicians treating nonmelanoma skin cancers have an understanding and awareness of these high-risk patients. The aim of this article is to discuss the factors that define a high-risk patient and to present some of the issues pertinent to their management.

References

  1. M. P. Staples, M. Elwood, R. C. Burton, J. L. Williams, R. Marks, and G. G. Giles, “Non-melanoma skin cancer in Australia: the 2002 national survey and trends since 1985,” The Medical Journal of Australia, vol. 184, no. 1, pp. 6–10, 2006. View at: Google Scholar
  2. R. C. Nolan, M. T.-L. Chan, and P. J. Heenan, “A clinicopathologic review of lethal nonmelanoma skin cancers in Western Australia,” Journal of the American Academy of Dermatology, vol. 52, no. 1, pp. 101–108, 2005. View at: Publisher Site | Google Scholar
  3. D. Czarnecki, M. P. Staples, A. Mar, G. Giles, and C. Meehan, “Metastases from squamous cell carcinoma of the skin in Southern Australia,” Dermatology, vol. 189, no. 1, pp. 52–54, 1994. View at: Google Scholar
  4. B. S. Cherpelis, C. Marcusen, and P. G. Lang, “Prognostic factors for metastasis in squamous cell carcinoma of the skin,” Dermatologic Surgery, vol. 28, no. 3, pp. 268–273, 2002. View at: Publisher Site | Google Scholar
  5. B. A. Moore, R. S. Weber, V. Prieto et al., “Lymph node metastases from cutaneous squamous cell carcinoma of the head and neck,” Laryngoscope, vol. 115, no. 9, pp. 1561–1567, 2005. View at: Publisher Site | Google Scholar
  6. D. S. Cassarino, D. P. DeRienzo, and R. J. Barr, “Cutaneous squamous cell carcinoma: a comprehensive clinicopathologic classification—part two,” Journal of Cutaneous Pathology, vol. 33, no. 4, pp. 261–279, 2006. View at: Publisher Site | Google Scholar
  7. L. H. Sobin and Ch. Wittekind, Eds., TNM Classification of Malignant Tumours, John Wiley & Sons, New York, NY, USA, 6th edition, 2002.
  8. D. E. Rowe, R. J. Carroll, and C. L. Day Jr., “Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip,” Journal of the American Academy of Dermatology, vol. 26, no. 6, pp. 976–990, 1992. View at: Google Scholar
  9. J. T. Mullen, L. Feng, Y. Xing et al., “Invasive squamous cell carcinoma of the skin: defining a high-risk group,” Annals of Surgical Oncology, vol. 13, no. 7, pp. 902–909, 2006. View at: Publisher Site | Google Scholar
  10. D. H. Kraus, J. F. Carew, and L. B. Horrison, “Regional lymph node metastasis from cutaneous squamous cell carcinoma,” Archives of Otolaryngology—Head and Neck Surgery, vol. 124, no. 5, pp. 582–587, 1998. View at: Google Scholar
  11. M. J. Veness, C. E. Palme, and G. J. Morgan, “High-risk cutaneous squamous cell carcinoma of the head and neck: results from 266 treated patients with metastatic lymph node disease,” Cancer, vol. 106, no. 11, pp. 2389–2396, 2006. View at: Publisher Site | Google Scholar
  12. V. Rodolico, E. Barresi, R. Di Lorenzo et al., “Lymph node metastasis in lower lip squamous cell carcinoma in relation to tumour size, histologic variables and p27kip1 protein expression,” Oral Oncology, vol. 40, no. 1, pp. 92–98, 2004. View at: Publisher Site | p27kip1%20protein%20expression&author=V. Rodolico&author=E. Barresi&author=R. Di Lorenzo et al.&publication_year=2004" target="_blank">Google Scholar
  13. H. Breuninger, G. Schaumburg-Lever, J. Holzschuh, and H. P. Horny, “Desmoplastic squamous cell carcinoma of skin and vermilion surface. A highly malignant subtype of skin cancer,” Cancer, vol. 79, no. 5, pp. 915–919, 1997. View at: Publisher Site | Google Scholar
  14. C. C. Huang and S. M. Boyce, “Surgical margins of excision for basal cell carcinoma and squamous cell carcinoma,” Seminars in Cutaneous Medicine and Surgery, vol. 23, no. 3, pp. 167–173, 2004. View at: Publisher Site | Google Scholar
  15. R. Grover, R. G. Douglas, and J. H.F. Shaw, “Carcinoma of the lip in Auckland, New Zealand, 1969–1987,” Head and Neck, vol. 11, no. 3, pp. 264–268, 1989. View at: Google Scholar
  16. J. G. De Visscher, P. J. J. Gooris, A. Vermey, and J. L. N. Roodenburg, “Surgical margins for resection of squamous cell carcinoma of the lower lip,” International Journal of Oral and Maxillofacial Surgery, vol. 31, no. 2, pp. 154–157, 2002. View at: Publisher Site | Google Scholar
  17. D. G. Brodland and J. A. Zitelli, “Surgical margins for excision of primary cutaneous squamous cell carcinoma,” Journal of the American Academy of Dermatology, vol. 27, no. 2, part 1, pp. 241–248, 1992. View at: Google Scholar
  18. D. J. Thomas, A. R. King, and B. G. Peat, “Excision margins for nonmelanotic skin cancer,” Plastic and Reconstructive Surgery, vol. 112, no. 1, pp. 57–63, 2003. View at: Publisher Site | Google Scholar
  19. E. Tavin and M. Persky, “Metastatic cutaneous squamous cell carcinoma of the head and neck region,” Laryngoscope, vol. 106, no. 2, pp. 156–158, 1996. View at: Publisher Site | Google Scholar
  20. H. Breuninger, B. Black, and G. Rassner, “Brief scientific statement: microstaging of squamous cell carcinomas,” American Journal of Clinical Pathology, vol. 94, no. 5, pp. 624–627, 1990. View at: Google Scholar
  21. A. Garcia-Serra, R. W. Hinerman, W. M. Mendenhall et al., “Carcinoma of the skin with perineural invasion,” Head and Neck, vol. 25, no. 12, pp. 1027–1033, 2003. View at: Publisher Site | Google Scholar
  22. H. F. Frierson Jr. and P. H. Cooper, “Prognostic factors in squamous cell carcinoma of the lower lip,” Human Pathology, vol. 17, no. 4, pp. 346–354, 1986. View at: Google Scholar
  23. M. W. McCord, W. M. Mendenhall, J. T. Parsons, and F. P. Flowers, “Skin cancer of the head and neck with incidental microscopic perineural invasion,” International Journal of Radiation Oncology, Biology, Physics, vol. 43, no. 3, pp. 591–595, 1999. View at: Publisher Site | Google Scholar
  24. P. G. Lang Jr., M. A. Braun, and R. Kwatra, “Aggressive squamous carcinomas of the scalp,” Dermatologic Surgery, vol. 32, no. 9, pp. 1163–1170, 2006. View at: Publisher Site | Google Scholar
  25. C. J. O'Brien, “The parotid gland as a metastatic basin for cutaneous cancer,” Archives of Otolaryngology—Head and Neck Surgery, vol. 131, no. 7, pp. 551–555, 2005. View at: Publisher Site | Google Scholar
  26. L. E. Afzelius, M. Gunnarsson, and H. Nordgren, “Guidelines for prophylactic radical lymph node dissection in cases of carcinoma of the external ear,” Head and Neck Surgery, vol. 2, no. 5, pp. 361–365, 1980. View at: Google Scholar
  27. S. Y. Lai, G. S. Weinstein, A. A. Chalian, D. I. Rosenthal, and R. S. Weber, “Parotidectomy in the treatment of aggressive cutaneous malignancies,” Archives of Otolaryngology—Head and Neck Surgery, vol. 128, no. 5, pp. 521–526, 2002. View at: Google Scholar
  28. J. G. Vartanian, A. L. Carvalho, M. J. De Araújo Filho, M. Hattori Jr., J. Magrin, and L. P. Kowalski, “Predictive factors and distribution of lymph node metastasis in lip cancer patients and their implications on the treatment of the neck,” Oral Oncology, vol. 40, no. 2, pp. 223–227, 2004. View at: Publisher Site | Google Scholar
  29. M. J. Veness, D. I. Quinn, C. S. Ong et al., “Aggressive cutaneous malignancies following cardiothoracic transplantation: the Australian experience,” Cancer, vol. 85, no. 8, pp. 1758–1764, 1999. View at: Publisher Site | Google Scholar
  30. J.-C. Martinez, C. O. Clark, T. Stasko et al., “Defining the clinical course of metastatic skin cancer in organ transplant recipients,” Archives of Dermatology, vol. 139, no. 3, pp. 301–306, 2003. View at: Publisher Site | Google Scholar
  31. K. E. Southwell, J. M. Chaplin, R. L. Eisenberg, N. P. McIvor, and R. P. Morton, “Effect of immunocompromise on metastatic cutaneous squamous cell carcinoma in the parotid and neck,” Head and Neck, vol. 28, no. 3, pp. 244–248, 2006. View at: Publisher Site | Google Scholar
  32. K. Mehrany, R. H. Weenig, K. K. Lee, M. R. Pittelkow, and C. C. Otley, “Increased metastasis and mortality from cutaneous squamous cell carcinoma in patients with chronic lymphocytic leukemia,” Journal of the American Academy of Dermatology, vol. 53, no. 6, pp. 1067–1071, 2005. View at: Publisher Site | Google Scholar
  33. J. A. Carucci, J. C. Martinez, N. C. Zeitouni et al., “In-transit metastasis from primary cutaneous squamous cell carcinoma in organ transplant recipients and nonimmunosuppressed patients: clinical characteristics, management, and outcome in a series of 21 patients,” Dermatologic Surgery, vol. 30, no. 4, part 2, pp. 651–655, 2004. View at: Publisher Site | Google Scholar
  34. S. J. Miller, “The national comprehensive cancer network (NCCN) guidelines of care for nonmelanoma skin cancers,” Dermatologic Surgery, vol. 26, no. 3, pp. 289–292, 2000. View at: Google Scholar
  35. R. Motley, P. Kersey, and C. Lawrence, “Multiprofessional guidelines for the management of the patient with primary cutaneous squamous cell carcinoma,” British Journal of Dermatology, vol. 146, no. 1, pp. 18–25, 2002. View at: Publisher Site | Google Scholar
  36. L. A. Drake, R. I. Ceilley, R. L. Cornelison et al., “Guidelines of care for cutaneous squamous cell carcinoma,” Journal of the American Academy of Dermatology, vol. 28, no. 4, pp. 628–631, 1993. View at: Google Scholar
  37. T. Stasko, M. D. Brown, J. A. Carucci et al., “Guidelines for the management of squamous cell carcinoma in organ transplant recipients,” Dermatologic Surgery, vol. 30, no. 4, part 2, pp. 642–650, 2004. View at: Publisher Site | Google Scholar
  38. A. S. Ross and C. D. Schmults, “Sentinel lymph node biopsy in cutaneous squamous cell carcinoma: a systematic review of the English literature,” Dermatologic Surgery, vol. 32, no. 11, pp. 1309–1321, 2006. View at: Publisher Site | Google Scholar
  39. M. J. Veness, “Treatment recommendations in patients diagnosed with high-risk cutaneous squamous cell carcinoma,” Australasian Radiology, vol. 49, no. 5, pp. 365–376, 2005. View at: Publisher Site | Google Scholar

Copyright © 2007 Michael J. Veness. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

0 Views | 0 Downloads | 0 Citations
 PDF  Download Citation  Citation
 Order printed copiesOrder