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Tongue base mucosectomy for carcinoma of unknown primary using endoscopic electrocautery: rationale for wider implementation of an institutionally restricted technique

  • C R Davies-Husband (a1)

Cervical metastasis from an unknown primary site invariably results in pan-mucosal irradiation if a primary tumour is not identified. Transoral robotic and laser-assisted mucosectomy are valid techniques to increase diagnostic rates, but these remain restricted to certain centres. This paper describes, in detail, a technique in which mucosectomy is performed via endoscopic electrocautery.


Patients were prospectively recruited between May 2017 and June 2018. Inclusion criteria stipulated biopsy-proven metastatic cervical squamous cell carcinoma, with negative findings on magnetic resonance imaging and positron emission tomography/computed tomography, in addition to examination under anaesthetic, tonsillectomy and ‘blind’ tongue base biopsies without tumour identification, prior to mucosectomy.


Of nine patients, a mucosal primary was identified in four (44.4 per cent), for which ipsilateral intensity-modulated radiotherapy was advocated in three and completion tongue base resection in the fourth. Dysplasia was demonstrated in two further patients, which provided information relevant to radiotherapy fields and post-treatment surveillance. No surgical complications were identified.


Tongue base mucosectomy using electrocautery and conventional tonsillectomy equipment is a safe, effective technique in the identification of cervical metastasis from an unknown primary site. It expands the potential breadth of use, quickens prolonged diagnostic pathways and obviates the necessity for pan-mucosal irradiation.

Corresponding author
Author for correspondence: Dr C R Davies-Husband, Head and Neck Unit, Queen Victoria Hospital, Holtye Rd, East Grinstead RH19 3DZ, UK E-mail:
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Dr C R Davies-Husband takes responsibility for the integrity of the content of the paper

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1Strojan, P, Ferlito, A, Medina, JE, Woolgar, JA, Rinaldo, A, Robbins, KT et al. Contemporary management of lymph node metastases from an unknown primary to the neck: I. A review of diagnostic approaches. Head Neck 2013;35:123–32
2Cianchetti, M, Mancuso, AA, Amdur, RJ, Werning, JW, Kirwan, J, Morris, CG et al. Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site. Laryngoscope 2009;119:2348–54
3Pattani, KM, Goodier, M, Lilien, D, Kupferman, T, Caldito, G, Nathan, CO. Utility of panendoscopy for the detection of unknown primary head and neck cancer in patients with a negative PET/CT scan. Ear Nose Throat J 2011;90:1620
4Bhide, SA, Ahmed, M, Newbold, K, Harrington, KJ, Nutting, CM. The role of intensity-modulated radiotherapy in head and neck cancer. Indian J Cancer 2010;47:267–73
5Grau, C, Johansen, LV, Jakobsen, J, Geertsen, P, Andersen, E, Jensen, BB. Cervical lymph node metastases from unknown primary tumours. Results from a national survey by the Danish Society for Head and Neck Oncology. Radiother Oncol 2000;55:121–9
6Haas, I, Hoffmann, TK, Engers, R, Ganzer, U. Diagnostic strategies in cervical carcinoma of an unknown primary (CUP). Eur Arch Otorhinolaryngol 2002;259:325–33
7Mehta, V, Johnson, P, Tassler, A, Kim, S, Ferris, RL, Nance, M et al. A new paradigm for the diagnosis and management of unknown primary tumors of the head and neck: a role for transoral robotic surgery. Laryngoscope 2013;123:146–51
8Mackenzie, K, Watson, M, Jankowska, P, Bhide, S, Simo, R. Investigation and management of the unknown primary with metastatic neck disease: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2016;130:170–5
9Nagel, TH, Hinni, ML, Hayden, RE, Lott, DG. Transoral laser microsurgery for the unknown primary: role for lingual tonsillectomy. Head Neck 2014;36:942–6
10Tanzler, ED, Amdur, RJ, Morris, CG, Werning, JW, Mendenhall, WM. Challenging the need for random directed biopsies of the nasopharynx, pyriform sinus, and contralateral tonsil in the workup of unknown primary squamous cell carcinoma of the head and neck. Head Neck 2016;38:7881
11Winter, SC, Ofo, E, Meikle, D, Silva, P, Fraser, L, O'Hara, J et al. Trans-oral robotic assisted tongue base mucosectomy for investigation of cancer of unknown primary in the head and neck region. The UK experience. Clin Otolaryngol 2017;42:1247–51
12Hatten, KM, O'Malley, BW Jr, Bur, AM, Patel, MR, Rassekh, CH, Newman, JG et al. Transoral robotic surgery-assisted endoscopy with primary site detection and treatment in occult mucosal primaries. JAMA Otolaryngol Head Neck Surg 2017;143:267–73
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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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