FREQUENCY AND THERAPEUTIC IMPLICATIONS OF SKIP METASTASES IN THE NECKFROM SQUAMOUS CARCINOMA OF THE ORAL TONGUE

Background. Supraomohyoid neck dissection is an adequate operation for the elective treatment of the neck for patients with oral cavity canc er. Squamous cell carcinoma of the oral tongue, however, may metastasi ze to clinically negative nodes in 20% to 30% of patients. These nodes usually are located in levels I-III. Methods. The medical records of 277 previously untreated patients with squamous cell carcinoma of the oral tongue were reviewed between the years 1970 and 1990. All patient s had a glossectomy and a neck dissection as pari of their initial tre atment. Patients were evaluated as to the findings in their neck. The following group of patients were included: (1) patients who had level III nodes positive, without disease in levels I and II; (2) patients w ith disease in level IV; (3) patients with disease in level IIB or III B, and; (4) patients who were electively dissected and whose neck did not demonstrate any pathologically involved nodes, but level IV was no t included in the dissection and the patient subsequently developed pa thologically positive nodes in level IV. Results. Of all patients, 15. 8% had either level IV metastasis as the only manifestation of disease in the neck or the level III node was the only node present without d isease in level I-II. Conclusion. The usual supraomohyoid neck dissect ion is inadequate for a complete pathologic evaluation of all the node s at risk for patients with squamous carcinoma of the oral tongue. Thi s may create a dilemma in determining whether postoperative radiothera py is necessary. Consequently, all patients with squamous cell carcino ma of the oral tongue should have levels I-IV nodes removed if an elec tive neck dissection is part of their initial therapy. (C) 1997 John W iley & Sons, Inc.