Axillary nodal metastases in head and neck cancer

Background. Axillary node metastasis is an uncommon occurrence in squamous carcinoma of the upper aerodigestive tract. Methods. The tumor registry of The Johns Hopkins University Department of O tolaryngology-Head and Neck Surgery contained four cases of metastasis to t he axilla from head and neck primary sites. A retrospective review of these cases was performed. Results: Each patient had been initially treated for cancer years earlier i ncluding surgery and radiation to the neck. A recurrent cancer or a new pri mary then developed in the upper aerodigestive tract prior to the developme nt of the axillary metastases. Conclusions. The common course of disease in these patients suggests that a lteration of the lymphatic anatomy by previous treatment may have caused a new pattern of metastatic spread upon reseeding from the mucosa, resulting in the axillary metastases. Routine surveillance of the axillae by physical examination and/or computerized imaging in at risk patients may permit the early diagnosis of axillary metastases. (C) 1999 John Wiley & Sons, Inc.