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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: ricard.simo@gstt.nhs.uk
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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

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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

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