REGIONAL LYMPH-NODE METASTASIS FROM CUTANEOUS SQUAMOUS-CELL CARCINOMA

Objective: To characterize clinical presentation and prognostic factor s in patients with histologically proven regional lymph node metastasi s from cutaneous squamous cell carcinoma of head and neck origin. Desi gn: Retrospective, nonrandomized case series. Setting: Tertiary referr al center. Patients: Forty-five patients treated between 1984 and 1995 with regional metastatic squamous cell carcinoma of cutaneous head an d neck origin. Intervention: Forty-one patients underwent neck dissect ion (20 with parotidectomy) and 4 patients underwent parotidectomy alo ne. Thirty-six patients (80%) received postoperative radiation therapy with a mean dose of 60 Gy (range, 34-71 Gy). Main Outcome Measures: R ecurrences and survival by univariate analysis using the Kaplan-Meier product-limit method. The log-rank test was used to evaluate prognosti c significance of clinical variables. Results: Follow-up ranged from 2 months to 10 years (mean, 21 months). Compared with historical contro ls, a greater percentage of patients in our population with regional l ymph node metastasis had primary lesions greater than 2 cm in diameter and 4 mm deep. Overall 2- and 5-year survival rates were 33% and 22%, respectively, while 5-year disease-free survival rate was 34%. Clinic al staging of the neck proved to be the only factor of prognostic valu e (P<.01). Treatment failures occurred in 22 patients. Conclusions: Fo r the small subset of patients with regional metastasis from cutaneous squamous cell carcinoma, survival remains poor despite multimodality treatment. Clinical stage of the neck was the only factor that predict ed outcome.