Original Article

Concurrent primary and metastatic cutaneous head and neck squamous cell carcinoma: Analysis of prognostic factors^†^‡

Timothy McLean MBBS

Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, New South Wales, Sydney, Australia

Search for more papers by this author

Markus Brunner MD,

Corresponding Author

Markus Brunner MD

[email protected]

Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria

The first 2 authors contributed equally to this work.

Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, New South Wales, Sydney, AustraliaSearch for more papers by this author

Ardalan Ebrahimi MBBS,

Ardalan Ebrahimi MBBS

Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, New South Wales, Sydney, Australia

Search for more papers by this author

Kan Gao,

Kan Gao

Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, New South Wales, Sydney, Australia

Search for more papers by this author

Sydney Ch'ng MBBS,

Sydney Ch'ng MBBS

Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, New South Wales, Sydney, Australia

Search for more papers by this author

Michael J. Veness MD,

Michael J. Veness MD

Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria

Search for more papers by this author

Jonathan R. Clark MBBS,

Jonathan R. Clark MBBS

Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, New South Wales, Sydney, Australia

Head and Neck Cancer Service, Westmead Hospital, University of Sydney, Sydney, Australia

Search for more papers by this author

Timothy McLean MBBS,

Timothy McLean MBBS

Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, New South Wales, Sydney, Australia

Search for more papers by this author

Markus Brunner MD,

Corresponding Author

Markus Brunner MD

[email protected]

Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria

The first 2 authors contributed equally to this work.

Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, New South Wales, Sydney, AustraliaSearch for more papers by this author

Ardalan Ebrahimi MBBS,

Ardalan Ebrahimi MBBS

Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, New South Wales, Sydney, Australia

Search for more papers by this author

Kan Gao,

Kan Gao

Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, New South Wales, Sydney, Australia

Search for more papers by this author

Sydney Ch'ng MBBS,

Sydney Ch'ng MBBS

Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, New South Wales, Sydney, Australia

Search for more papers by this author

Michael J. Veness MD,

Michael J. Veness MD

Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria

Search for more papers by this author

Jonathan R. Clark MBBS,

Jonathan R. Clark MBBS

Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, New South Wales, Sydney, Australia

Head and Neck Cancer Service, Westmead Hospital, University of Sydney, Sydney, Australia

Search for more papers by this author

First published: 21 August 2012

https://doi.org/10.1002/hed.23102

Citations: 31

^‡

The authors have no conflict of interest to disclose.

Share a link

Email
Wechat
Bluesky

Abstract

Background

There is a small subgroup of patients with head and neck cutaneous squamous cell carcinoma (cSCC) in which nodal metastases present concurrently with the primary lesion. There is evidence that these tumors may represent a more aggressive subset of cSCC. The aim of this study was to determine whether alternative clinicopathologic prognostic factors should be applied to this patient cohort.

Methods

A retrospective analysis of data from prospective databases of 2 large head and neck cancer units in Sydney, Australia, was performed. Ninety-five patients with concurrent primary and nodal metastatic head and neck cSCC were suitable for inclusion in the study.

Results

Univariable analysis was performed for overall survival (OS) and disease-specific survival (DSS). OS was adversely affected by immunosuppression (p = .011) and nodal extracapsular spread (ECS) (p = .006). Similarly, immunosuppression (p = .005) and ECS (p = .005) indicated a worse outcome for DSS. ECS and immunosuppression remained significant in the multivariable analysis.

Conclusions

This study found that adverse prognostic factors were similar to the current evidence for nonconcurrent metastatic cSCC. In particular, the primary lesion had no significant influence on survival. © 2012 Wiley Periodicals, Inc. Head Neck, 2013

REFERENCES

1 Cancer Council Australia. Basal cell carcinoma, squamous cell carcinoma (and related lesions): a guide to clinical management in Australia [Online]. Sydney: Cancer Council Australia and Australian Cancer Network; 2008.
Google Scholar
2 Staples MP, Elwood M, Burton RC, Williams JL, Marks R, Giles GG. Non-melanoma skin cancer in Australia: the 2002 national survey and trends since 1985. Med J Aust 2006; 184: 6–10.
10.5694/j.1326-5377.2006.tb00086.x
PubMed Web of Science® Google Scholar
3 Czarnecki D, Staples M, Mar A, Giles G, Meehan C. Metastases from squamous cell carcinoma of the skin in southern Australia. Dermatology 1994; 189: 52–54.
10.1159/000246783
CAS PubMed Web of Science® Google Scholar
4 Veness MJ, Palme CE, Morgan GJ. High-risk cutaneous squamous cell carcinoma of the head and neck: results from 266 treated patients with metastatic lymph node disease. Cancer 2006; 106: 2389–2396.
10.1002/cncr.21898
PubMed Web of Science® Google Scholar
5 Brantsch KD, Meisner C, Shonfisch B, et al. Analysis of risk factors determining prognosis of cutaneous squamous-cell carcinoma: a prospective study. Lancet Oncol 2008; 9: 713–720.
10.1016/S1470-2045(08)70178-5
PubMed Web of Science® Google Scholar
6 Kyrgidis A, Tzellos TG, Kechagias N, et al. Cutaneous squamous cell carcinoma (SCC) of the head and neck: risk factors of overall and recurrence-free survival. Eur J Cancer 2010; 46: 1563–1572.
10.1016/j.ejca.2010.02.046
PubMed Web of Science® Google Scholar
7 Mourouzis C, Boynton A, Grant J, et al. Cutaneous head and neck SCCs and risk of nodal metastasis—UK experience. J Craniomaxillofac Surg 2009; 37: 443–447.
10.1016/j.jcms.2009.07.007
PubMed Web of Science® Google Scholar
8 Del Regato JA, Vuksanovic M. Radiotherapy of carcinomas of the skin overlying the cartilages of the nose and ear. Radiology 1962; 79: 203–208.
10.1148/79.2.203
CAS PubMed Web of Science® Google Scholar
9 Martinez JC, Otley CC, Stasko T, et al. Defining the clinical course of metastatic skin cancer in organ transplant recipients: a multicenter collaborative study. Arch Dermatol 2003; 139: 301–306.
10.1001/archderm.139.3.301
PubMed Web of Science® Google Scholar
10 Moore BA, Weber RS, Prieto CE, et al. Lymph node metastases from cutaneous squamous cell carcinoma of the head and neck. Laryngoscope 2005; 115: 1561–1567.
10.1097/01.mlg.0000173202.56739.9f
PubMed Web of Science® Google Scholar
11 Oddone N, Morgan GJ, Palme CE, et al. Metastatic cutaneous squamous cell carcinoma of the head and neck: the immunosuppression, treatment, extranodal spread, and margin status (ITEM) prognostic score to predict outcome and the need to improve survival. Cancer 2009; 115: 1883–1891.
10.1002/cncr.24208
CAS PubMed Web of Science® Google Scholar
12 Forest VI, Clark JR, Veness MJ, Milross C. N1S3: a revised staging system for head and neck cutaneous squamous cell carcinoma with lymph node metastases: results of 2 Australian Cancer Centers. Cancer 2010; 116: 1298–1304.
10.1002/cncr.24855
CAS PubMed Web of Science® Google Scholar
13 O'Brien CJ, McNeil EB, McMahon JD, Pathak I, Lauer CS, Jackson MA. Significance of clinical stage, extent of surgery, and pathologic findings in metastatic cutaneous squamous carcinoma of the parotid gland. Head Neck 2002; 24: 417–422.
10.1002/hed.10063
PubMed Web of Science® Google Scholar
14 Veness MJ, Porceddu S, Palme S, Morgan GJ. Cutaneous head and neck squamous cell carcinoma metastatic to parotid and cervical lymph nodes. Head Neck 2007; 29: 621–631.
10.1002/hed.20576
PubMed Web of Science® Google Scholar
15 Ebrahimi A, Moncrieff MD, Clark JR, et al. Predicting the pattern of regional metastases from cutaneous squamous cell carcinoma of the head and neck based on location of the primary. Head Neck 2010; 32: 1288–1294.
10.1002/hed.21332
CAS PubMed Web of Science® Google Scholar
16 Brunner M, Veness MJ, Ch'ng S, Elliot M, Clark JR. Distant metastases from cutaneous squamous cell carcinoma: analysis of AJCC stage IV. Head Neck January 20, 2012. doi:10.1002/hed.22913. [Epub ahead of print]
Google Scholar
17 Sheil AG, Disney AP, Mathew TH, Amiss N. De novo malignancy emerges as a major cause of morbidity and late failure in renal transplantation. Transplant Proc 1993; 25: 1383–1384.
CAS PubMed Web of Science® Google Scholar
18 Otley CC, Berg D, Ulrich C, et al. Reduction of immunosuppression for transplant-associated skin cancer: expert consensus survey. Br J Dermatol 2006; 154: 395–400.
10.1111/j.1365-2133.2005.07087.x
CAS PubMed Web of Science® Google Scholar
19 Veness MJ, Morgan GJ, Palme CE, Gebski V. Surgery and adjuvant radiotherapy in patients with cutaneous head and neck squamous cell carcinoma metastatic to lymph nodes: combined treatment should be considered best practice. Laryngoscope 2005; 115: 870–875.
10.1097/01.MLG.0000158349.64337.ED
PubMed Web of Science® Google Scholar
20 Joseph MG, Zulueta WP, Kennedy PJ. Squamous cell carcinoma of the skin of the trunk and limbs: the incidence of metastases and their outcome. Aust N Z J Surg 1992; 62: 697–701.
10.1111/j.1445-2197.1992.tb07065.x
CAS PubMed Web of Science® Google Scholar
21 Kelder W, Ebrahimi A, Forest V-I, Gao K, Murali R, Clark JR. Cutaneous head and neck squamous cell carcinoma with regional metastases: the prognostic importance of soft tissue metastases and extranodal spread. Ann Surg Oncol 2012; 19: 274–279.
10.1245/s10434-011-1986-7
PubMed Web of Science® Google Scholar
22 Nolan RC, Chan MTL, Heenan PJ. A clinicopathologic review of lethal nonmelanoma skin cancers in Western Australia. J Am Acad Dermatol 2005; 52: 101–108.
10.1016/j.jaad.2004.08.016
PubMed Web of Science® Google Scholar
23 Clayman GL, Lee JJ, Holsinger FC, et al. Mortality risk from squamous cell skin cancer. J Clin Oncol 2005; 23: 759–765.
10.1200/JCO.2005.02.155
PubMed Web of Science® Google Scholar
24 Edge SBB, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging handbook from the AJCC cancer staging manual ( 7th ed.). New York: Springer; 2010.
Google Scholar
25 Hinerman R, Amdur R, Morris CG, et al. Cutaneous squamous cell carcinoma metastatic to parotid-area lymph nodes. Laryngoscope 2008; 118: 1989–1996.
10.1097/MLG.0b013e318180642b
PubMed Web of Science® Google Scholar
26 Khurana VG, Mentis DH, O'Brien CJ, Hurst TL, Stevens GN, Packham NA. Parotid and neck metastases from cutaneous squamous cell carcinoma of the head and neck. Am J Surg 1995; 170: 446–450.
10.1016/S0002-9610(99)80326-2
CAS PubMed Web of Science® Google Scholar

Citing Literature

Volume35, Issue8

August 2013

Pages 1144-1148

Concurrent primary and metastatic cutaneous head and neck squamous cell carcinoma: Analysis of prognostic factors^†^‡

Abstract

Background

Methods

Results

Conclusions

REFERENCES

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Concurrent primary and metastatic cutaneous head and neck squamous cell carcinoma: Analysis of prognostic factors†‡

Abstract

Background

Methods

Results

Conclusions

REFERENCES

Citing Literature

References

Related

Information

Concurrent primary and metastatic cutaneous head and neck squamous cell carcinoma: Analysis of prognostic factors^†^‡