2018-19 Section 7-Neoplastic and Inflammatory Diseases of the Head and Neck eBook

Reprinted by permission of Otolaryngol Head Neck Surg. 2017; 156(5):863-869.

Original Research—Head and Neck Surgery

Otolaryngology– Head and Neck Surgery 2017, Vol. 156(5) 863–869 American Academy of Otolaryngology—Head and Neck

Factors Associated with Recurrence and Regional Adenopathy for Head and Neck Cutaneous Squamous Cell Carcinoma

Surgery Foundation 2017 Reprints and permission:

sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599817697053 http://otojournal.org

Brianna N. Harris, MD 1 , Ahmed Bayoumi 1 , Shyam Rao, MD 2 , Michael G. Moore, MD 1 , D. Gregory Farwell, MD 1 , and Arnaud F. Bewley, MD 1

N onmelanoma skin cancer (NMSC) is the most common malignancy in the United States, with . 2 million patients estimated to have been treated in 2006. 1 The incidence of these tumors is also rising, most likely due to increasing sun exposure in younger patients. 2 This growing epidemic of NMSC has a dramatic impact on our health care economy, with an estimated $650 million spent on management per year. 3 About 20% of NMSCs are cuta- neous squamous cell carcinomas (CSCCs), with 75% to 80% of those occurring in the head and neck. 1,2 Though less common than cutaneous basal cell carcinoma, CSCCs are more morbid tumors, largely due to their potential for meta- static spread, and the majority of the mortality inflicted by NMSC is due to CSCC. With early-stage disease, recurrence rates are generally well below 10%. 4-6 However, patients with locally advanced or regionally metastatic disease can have 5- year recurrence rates as high as 63%, with resulting 5-year overall survival estimates between 44% and 71%. 7-10 Our knowledge of CSCCs is limited, as data on these tumors are not collected by the Surveillance Epidemiology and End Results database or the National Cancer Database. What we do understand of this disease comes largely from single-institution series that describe experiences with treat- ment and outcomes. The largest series of patients with CSCCs have primarily been published by dermatologists who describe early-stage tumors affecting all subsites of the head, neck, and body. In these series, consistent predictors of recurrence and poor survival have been identified as tumor diameter . 2 cm, depth of invasion (DOI) . 2 mm, perineural invasion (PNI), poorly differentiated histology, Sacramento, California, USA 2 Department of Radiation Oncology, University of California–Davis, Sacramento, California, USA This article was presented at the 2016 AAO-HNSF Annual Meeting & OTO EXPO; September 18-21, 2016; San Diego, California. Corresponding Author: Brianna N. Harris, MD, Department of Otolaryngology, University of California–Davis, 2521 Stockton Blvd, Suite 7200, Sacramento, CA 95817, USA. Email: brnharris@ucdavis.edu 1 Department of Otolaryngology, University of California–Davis,

No sponsorships or competing interests have been disclosed for this article.

Abstract Objective. Cutaneous squamous cell carcinoma (CSCC) is one of the most common malignancies worldwide. With advanced CSCC of the head and neck, there is conflicting evidence on what constitutes high-risk disease. Our objec- tive is to evaluate which factors are predictive of recurrence and nodal spread and survival.

Study Design. Case series with chart review.

Setting. Tertiary academic institution.

Subjects and Methods. Patients with advanced head and neck CSCC treated with primary resection identified by chart review. Results. A total of 212 patients met inclusion criteria, with a mean age of 70.4 years; 87.3% were men. Mean tumor diameter was 3.65 cm, with an average depth of invasion of 1.38 cm. The mean follow-up time was 35 months (median, 21.5), and over that period 67 recurrences were recorded, 49 of which were local. The 5-year Kaplan-Meier estimate of disease-free survival for the cohort was 53.2%. On Cox multivariate analysis, recur- rent disease, perineural invasion (PNI), and poorly differentiated histology were independent predictors of recurrence. On multi- nomial logistic regression, patients with primary tumors on the ear, cheek, temple, or lip, as well as those with PNI, were more likely to present with nodal metastasis. Conclusion. For advanced CSCCs of the head and neck, patients with recurrent disease, PNI, and poorly differentiated tumors are at highest risk for local recurrence. Patients with tumors or the ear, cheek, temple, or lip, as well as those with PNI, are at increased risk of harboring nodal disease.

Keywords cutaneous squamous cell carcinoma, skin cancer, recurrence, regional adenopathy

Received November 9, 2016; revised January 16, 2017; accepted February 9, 2017.

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