Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-24T09:25:27.595Z Has data issue: false hasContentIssue false
  • English
  • Français

Direct skin involvement of cervical lymph node metastasis from mucosal squamous cell carcinoma of the head and neck

Published online by Cambridge University Press:  10 December 2012

A D Dragan ,
I J Nixon ,
A A Orabi ,
A Manganaris ,
J-P Jeannon ,
M T Guerrero-Urbano  and
R Simo
A D Dragan
Affiliation:
Department of Otorhinolaryngology-Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
I J Nixon
Affiliation:
Department of Otorhinolaryngology-Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
A A Orabi
Affiliation:
Department of Otorhinolaryngology-Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
A Manganaris
Affiliation:
Department of Otorhinolaryngology-Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
J-P Jeannon
Affiliation:
Department of Otorhinolaryngology-Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
M T Guerrero-Urbano
Affiliation:
Department of Clinical and Radiation Oncology, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
R Simo*
Affiliation:
Department of Otorhinolaryngology-Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
*
Address for correspondence: Mr Ricard Simo, Department of Otorhinolaryngology-Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK Fax: +44 (0)207 188 2206 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Direct skin involvement of nodal metastasis from mucosal head and neck squamous cell carcinoma has traditionally been considered a poor prognostic indicator.

Methods:

This retrospective review identified eight patients (five with mucosal upper aerodigestive and three with occult primary squamous cell carcinoma) who presented between 2000 and 2007 with direct skin involvement of nodal metastasis.

Results:

Five patients were treated with extended radical and three with extended modified radical neck dissection. Closure was achieved directly (four cases), with local (two) or pedicled (two) flaps. Surgery was always followed by radiotherapy (pan-mucosal or to the primary site). The five-year recurrence-free and disease-specific survival rates were 100 per cent.

Conclusion:

It is exceptionally rare to encounter direct skin involvement of metastatic lymph nodes from mucosal head and neck squamous cell carcinoma without evidence of involvement of other anatomical structures. Surgical intervention is possible and combined modality treatment with curative intent is essential, as most patients can have a favourable outcome.

Keywords

Neoplasm MetastasisCarcinomaSquamous Cell
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 127 , Issue 2 , February 2013 , pp. 181 - 186
Copyright
Copyright © JLO (1984) Limited 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented in preliminary form (2-year follow up) at the 3rd European Conference on Head and Neck Oncology, 8–10 May 2008, Zagreb, Croatia

References

1Yoskovitch, A, Hier, MP, Okrainec, A, Black, MJ, Rochon, L. Skin metastases in squamous cell carcinoma of the head and neck. Otolaryngol Head Neck Surg 2001;124:248–52CrossRefGoogle ScholarPubMed
2Kmucha, ST, Troxel, JM. Dermal metastasis in epidermal carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg 1993;119:326–30CrossRefGoogle Scholar
3Pitman, KT, Johnson, JT. Skin metastases from head and neck squamous cell carcinoma: incidence and impact. Head Neck 1999;21:560–53.0.CO;2-Q>CrossRefGoogle ScholarPubMed
4Sobin, L, Wittekind, C. TNM Classification of Malignant Tumours, 6th edn.New York: Wiley-Liss, 2002Google Scholar
5Oken, MM, Creech, RH, Tormey, DC, Horton, J, Davis, TE, McFadden, ET et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982;5:649–55CrossRefGoogle ScholarPubMed
6Harish, K. Neck dissections: radical to conservative. World J Surg Oncol 2005;3:21CrossRefGoogle ScholarPubMed
7Cole, RD, McGuirt, WF. Prognostic significance of skin involvement from mucosal tumors of the head and neck. Arch Otolaryngol Head Neck Surg 1995;121:1246–8CrossRefGoogle ScholarPubMed
8Stavrianos, SD, Ragbir, M, McLean, NR, Kelly, CG, Soames, JV. Head and neck skin involvement by non-cutaneous head and neck cancers: free flap reconstruction. Eur J Surg Oncol 2000;26:594–8CrossRefGoogle ScholarPubMed
9Jose, J, Coatesworth, AP, Johnston, C, MacLennan, DM. Cervical node metastases in squamous cell carcinoma of the upper aerodigestive tract: the significance of extracapsular spread and soft tissue deposits. Head Neck 2003;6:451–6CrossRefGoogle Scholar
10Roh, JL, Kim, JS, Lee, JH, Cho, KJ, Choi, SH, Nam, SY et al. Utility of combined (18)F-fluorodeoxyglucose-positron emission tomography and computed tomography in patients with cervical metastases from unknown primary tumors. Oral Oncol 2009;45:218–24CrossRefGoogle ScholarPubMed
11Prim, MP, De Diego, JI, Hardisson, D, Madero, R, Nistal, M, Gavilan, J. Extracapsular spread and desmoplastic pattern in neck lymph nodes: two prognostic factors of laryngeal cancer. Ann Otol Rhinol Laryngol 1999;108:672–6CrossRefGoogle ScholarPubMed
12Yilmaz, T, Hosal, AS, Gedikoglu, G, Onerci, M, Gursel, B. Prognostic significance of vascular and perineural invasion in cancer of the larynx. Am J Otolaryngol 1998;19:83–8CrossRefGoogle ScholarPubMed
13Prim Espada, MP, De Diego Sastre, JI, Hardisson Hernaez, D, Gavilan Bouzas, J. Effect of extracapsular extension on cervical recurrence and survival of patients with laryngeal tumours [in Spanish]. Acta Otorrinolaringol Esp 1998;49:637–9Google Scholar
14Hirabayashi, H, Koshii, K, Uno, K, Ohgaki, H, Nakasone, Y, Fujisawa, T et al. Extracapsular spread of squamous cell carcinoma in neck lymph nodes: prognostic factors of laryngeal cancer. Laryngoscope 1991;101:502–6CrossRefGoogle ScholarPubMed
15Violaris, NS, O'Neil, D, Helliwell, TR, Caslin, AW, Roland, NJ, Jones, AS. Soft tissue cervical metastases of squamous carcinoma of the head and neck. Clin Otolaryngol 1994;19:394–9CrossRefGoogle ScholarPubMed
16Dequanter, D, Mboti, FB, Lothaire, P, Andry, G. Skin metastases from a head and neck carcinoma: a prognostic factor? B-ENT 2005;1:113–15Google ScholarPubMed