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Sentinel Node Biopsy in 105 High-Risk Cutaneous SCCs of the Head and Neck: Results of a Multicenter Prospective Study

  • Craig P. MooneyEmail author
  • Richard C. W. Martin
  • Richard Dirven
  • Bruce G. Ashford
  • Kerwin Shannon
  • Carsten E. Palme
  • Quan Ngo
  • James Wykes
  • Sarah Davies
  • Kan Gao
  • Sydney Ch’ng
  • Tsu-Hui Low
  • Ruta Gupta
  • Jonathan R. Clark
Head and Neck Oncology
  • 54 Downloads

Abstract

Background

Regional nodal metastases from cutaneous squamous cell carcinoma (cSCC) is strongly associated with a poor prognosis, but these metastases are difficult to predict clinically. Sentinel node biopsy (SNB) has been used for a wide range of malignancies to assess for regional nodal metastasis, but is not widely used for cSCC.

Methods

Patients presenting with high-risk cSCC of the head and neck with clinically N0 necks were offered SNB at the time of primary cSCC excision or secondary wide local excision. Patients with positive sentinel nodes were offered completion lymph node dissection, and all the patients were followed up at regular intervals for up to 5 years.

Results

In this study, 105 lesions underwent SNB, and 10 sentinel nodes (9.5%) were positive. In an additional five patients, regional recurrence developed after a negative sentinel node, with a total subclinical nodal metastasis rate of 14.3%. Nodal metastases were significantly associated with reduced disease-specific survival. The significant predictors of metastasis were four or more high-risk features or tumors with a concurrent invasion deeper than 5 mm and PNI.

Conclusion

For high-risk cSCC, SNB is a safe and feasible staging technique. The total number of high risk features and certain combinations of high-risk features predicted metastasis better than individual high-risk features.

Notes

Author Contributions

CPM: data curation, formal analysis, writing—original draft, writing—review and editing. RCWM: conceptualization, data curation, investigation, methodology, supervision, writing—review and editing. RD: data curation, formal analysis, supervision, writing—original draft, writing—review and editing. BGA: data curation, investigation, writing—review and editing. KS: data curation, investigation, writing—review and editing. CEP: data curation, investigation, writing—review and editing. QN: data curation, investigation, writing—review and editing. JW: data curation, investigation, writing—review and editing. SD: data curation, project administration, resources, writing—review and editing. KG: data curation, formal analysis, project administration, resources, writing—review and editing. SC: investigation, supervision, validation, writing—review and editing. T-HL: data curation, formal analysis, investigation, supervision, validation, writing—review and editing. RG: conceptualization, investigation, methodology, project administration, supervision, validation, writing—review and editing. JRC: conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, supervision, validation, visualization, writing—original draft, and writing—review and editing.

Funding

No specific funding.

Disclosures

There are no conflicts of interest.

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Craig P. Mooney
    • 1
    • 2
    Email author
  • Richard C. W. Martin
    • 1
    • 3
  • Richard Dirven
    • 1
    • 4
  • Bruce G. Ashford
    • 1
    • 5
    • 6
    • 7
  • Kerwin Shannon
    • 1
    • 8
  • Carsten E. Palme
    • 1
    • 8
  • Quan Ngo
    • 9
  • James Wykes
    • 1
    • 10
  • Sarah Davies
    • 1
  • Kan Gao
    • 1
  • Sydney Ch’ng
    • 1
    • 8
  • Tsu-Hui Low
    • 1
    • 8
  • Ruta Gupta
    • 1
    • 8
    • 11
  • Jonathan R. Clark
    • 1
    • 8
    • 10
  1. 1.Sydney Head and Neck Cancer Institute, Chris O’Brien LifehouseSydneyAustralia
  2. 2.Sydney Medical SchoolUniversity of SydneySydneyAustralia
  3. 3.Melanoma Unit, Waitemata Health and Auckland Regional Head and Neck ServiceUniversity of AucklandAucklandNew Zealand
  4. 4.Department of Head and Neck Oncology and SurgeryThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  5. 5.Illawarra and Shoalhaven Local Health DistrictWollongongAustralia
  6. 6.Illawarra Health and Medical Research InstituteWollongongAustralia
  7. 7.School of Biological SciencesUniversity of WollongongWollongongAustralia
  8. 8.Central Clinical SchoolUniversity of SydneySydneyAustralia
  9. 9.Liverpool HospitalLiverpoolAustralia
  10. 10.South West Clinical SchoolUniversity of NSWSydneyAustralia
  11. 11.Department of Tissue Pathology and Diagnostic OncologyRoyal Prince Alfred HospitalSydneyAustralia

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