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The article discusses the various treatments of patients with metastatic cutaneous squamous cell carcinoma of the head and neck. According to the study, majority of the patients treated with lymph node basin have died of the disease. Meanwhile, patients who underwent surgery and received adjuvant radiotherapy had a better outcome compared with patients who underwent surgery alone.

Background: Metastatic cutaneous squamous cell carcinoma arising from the scalp, although relatively uncommon, is associated with a poor outcome. Older men with a history of baldness and actinic scalp lesions are particularly at risk. Methods: Between 1980 and 2005, 27 patients with metastatic cutaneous squamous cell carcinoma of the scalp were referred to the Head and Neck Cancer Service at Westmead Hospital, Sydney. Relevant data were extracted from a prospectively maintained database. Patterns of recurrence and outcome were analysed. Results: Median age at diagnosis was 70 years and median follow up was 45 months in 26 men and one woman. Ten primary (index) lesions were located on the midline scalp, 14 left sided and 3 right sided. Median lesion size was 18 mm and median thickness was 5.5 mm. The median time between treatment of the scalp primary and the development of nodal metastases was 8 months. In 10 patients, nodal metastases were present at the time of primary treatment. Fifteen patients developed parotid metastases (+cervical nodes in 7 of 15) and 12 developed cervical only metastases (5 of 12 level V). All patients underwent nodal surgery and most (75%) also received adjuvant radiotherapy. At the last follow up, 41% of patients had died from their disease. Median survival after relapse was 9 months and all patients experiencing relapse died with most (11 of 13) dying from metastatic disease. Conclusion: Patients with metastatic cutaneous squamous cell carcinoma of the scalp have a poor prognosis with most dying from regional relapse. Those treated with surgery and adjuvant radiotherapy had a better outcome. [ABSTRACT FROM AUTHOR]

There is an increasing risk of cervical lymph node metastases as tumour thickness increases in patients with anterior tongue squamous cell carcinoma (SCC). The role of elective neck treatment in early anterior tongue cancer in unclear.Patients diagnosed with anterior tongue cancer and treated with glossectomy ± neck dissection were identified. The aim was to document the incidence of pathological lymph node metastases and outcome with increasing tumour thickness. The Cox proportional hazards model was used to identify prognostic factors. Survival curves were calculated using the Kaplan−Meier method.Between 1980 and 2002 99 patients (63 male and 36 female) with anterior tongue SCC were treated at Westmead Hospital, Sydney, and had a documented tumour thickness. Median age at diagnosis was 63 years (23−89 years). Median follow up was 37 months (6−205 months). Sixty-three patients underwent partial glossectomy and neck dissection. Thirty-six underwent partial glossectomy only. At the time of presentation 45/63 (71%) were clinically node negative. Using tumour thickness≤5 mm versus>5 mm the incidence of nodal metastases was 8% versus 51% (P = 0.007). On multivariate analysis pathological nodal involvement and advanced stage both significantly predicted survival. The 2-year disease-free survival difference based on tumour thickness (≤5 mm vs>5 mm) was 76% versus 65% (P = 0.47).Elective treatment to the ipsilateral neck is not indicated in all patients with anterior tongue cancer. However, for patients with a tumour thickness>5 mm it is recommended that they undergo treatment to the ipsilateral neck in the form of a supraomohyoid neck dissection. [ABSTRACT FROM AUTHOR]

Mucosal head and neck cancers usually occur in older males after years of smoking and alcohol abuse. Despite this, approximately 5% of cases occur in young adults. The aetiology remains unclear and the anterior tongue is a prevalent site. Prognosis has been reported as worse in young patients and some have proposed a more aggressive treatment approach. Patients diagnosed with previously untreated anterior tongue squamous cell carcinoma and treated with curative intent were identified. Retrospective and prospective data were collected. Univariate and multivariate analyses were undertaken using Cox regression analysis. The outcome of patients treated with anterior tongue cancer using a cut-off age of 40 years was compared. Between 1980 and 2000, 106 males and 58 females with anterior tongue squamous cell carcinoma were treated at Westmead Hospital. Median follow up was 47 months (6−210 months). Twenty-two patients (13.4%) were aged ≤40 years. Other than age, patient demographics, TNM stage and treatment approach were similar between the two groups. Eighty-one per cent had either a T1 or T2 primary. In total, 139 patients (84.8%) had surgery or surgery and radiotherapy. A total of 56 (34%) patients experienced a recurrent event, with nodal recurrence occurring most often as the first site ( n = 33, 59%). Young patients had a higher recurrence rate (45.5% vs 32.4%; P = 0.23). Relapse-free survival at 5 years was 62% versus 81% ( P = 0.27). Overall survival at 5 years was 65% versus 67% ( P = 0.74). In keeping with recently published evidence, young age at diagnosis with anterior tongue cancer did not portend worse outcome. There is therefore currently no strong evidence to support a different treatment approach in young patients. [ABSTRACT FROM AUTHOR]

Background Lymph node density ( LND) has been described as a prognostic factor for survival in patients with head and neck squamous cell carcinoma, particularly of the oral cavity. The aim of this study was to determine the prognostic significance of LND in patients with node positive oral tongue squamous cell carcinoma ( OTSCC). Methods Patients with pathological node positive OTSCC were identified in a retrospective review of prospectively collected data. The optimal cut-point for LND was determined using the minimum P-value method and the log-rank test. The impact of this LND cut-point on time to disease progression and overall survival was determined. Results In 72 patients with OTSCC, an LND of 14.3% was found to have the greatest separation using the log-rank test ( P < 0.001). LND ≤14.3% was predicted for longer time to disease progression with a median time of 73 months compared to 9.4 months in patients with an LND >14.3% (hazard ratio: 3.43; 95% confidence interval: 1.76-6.70; P < 0.001). LND was also a significant predictor of overall survival with a median overall survival with LND ≤14.3% of 82.3 months, compared with 14.7 months in patients with an LND >14.3% (hazard ratio: 3.28; 95% confidence interval: 1.61-6.68; P = 0.001). Patients with an LND >14.3% experienced a higher rate of regional recurrence. Conclusion Our findings confirm the prognostic significance of LND in patients with node positive OTSCC, with a similar LND cut-point value to other published series. Improving regional control in these high-risk patients may improve outcome. [ABSTRACT FROM AUTHOR]

Parathyroid cysts are rare and even more rarely cause a neck mass resembling a goitre. Such large parathyroid cysts may involve the mediastinum, growing to a sufficient size to produce symptoms related to obstruction, and if functioning, primary hyperparathyroidism. Parathyroid cysts should be considered in the list of differential diagnoses of anterior neck masses to allow for appropriate preoperative investigation to avoid unnecessary confusion at the time of operation. We report a case where a functioning parathyroid cyst presented as a retrosternal goitre to emphasize the potential pitfalls associated with their diagnosis and management. [ABSTRACT FROM AUTHOR]

Anaplastic thyroid carcinoma (ATC) accounts for <5% of all thyroid malignancies and is one of the most aggressive malignancies known. Survival is limited to months and death is often caused by uncontrolled neck disease. There is evidence that multimodality treatment, incorporating surgery (Sx), external beam radiotherapy (RT) and chemotherapy (CT), might enhance local control and improve survival. Between 1979 and 2002, 18 patients with ATC were referred to the multidisciplinary Head and Neck Cancer Service, Westmead Hospital, Sydney, Australia. The aim of the present study is to report on the treatment and outcome of these patients. Survival was calculated from the time of diagnosis until death using the Kaplan−Meier method. Median age at diagnosis was 72 years (29−92 years) in 12 women and six men. Five patients had distant metastases at diagnosis. Seven patients were treated with various combinations of Sx, RT and/or CT. Ten patients received a single modality, including three undergoing a total thyroidectomy. Many patients died from local disease progression. Only one patient received triple modality treatment (Sx/RT/CT), surviving 26 months, and maintaining local control until death. Sixteen patients died from disease with a median survival of 6.2 months (0.3−56.8 months). Most patients with ATC are incurable; however, a multimodality approach incorporating Sx and RT ± CT, in selected individuals, might improve local control and extend survival. [ABSTRACT FROM AUTHOR]

Merkel cell carcinoma is an aggressive primary cutaneous neuroendocrine carcinoma. Patients remain at high risk of locoregional and distant relapse despite treatment. Most studies support the incorporation of locoregional adjuvant radiotherapy in reducing the risk of relapse. Between 1980 and 2002, 86 patients diagnosed with Merkel cell carcinoma were treated with curative intent at Westmead Hospital, Sydney. Multivariate analysis was performed using Cox regression analysis. Disease-free survival and overall survival was calculated using Kaplan–Meier survival curves. Median age at diagnosis was 75 years (range 46–89 years) in 49 men and 37 women. Median duration of follow up was 31 months (range 6–153 months). Fifty-one (59%) patients presented with a primary lesion, 19 (22%) with a primary lesion and clinical nodal disease and 16 (19%) with lymph node metastases from an unknown primary. A total of 47 of 86 (55%) relapsed with regional nodal relapse, the commonest site of first relapse. Local relapse was similar for patients undergoing surgery (5/37; 14%) compared with surgery and adjuvant radiotherapy (3/25; 12%). Nodal relapse occurred in 14 of 36 (37%) treated with surgery compared with 7 of 38 (18%) patients treated with surgery and adjuvant radiotherapy. Patients treated with surgery and adjuvant radiotherapy experienced a better median disease free survival compared to those undergoing surgery alone (10.5 months vs 4 months; P < 0.01). The 5-year overall and disease-free survival rate for the entire study population was 47% and 25%, respectively. Twenty-six patients (30%) died as a result of Merkel cell carcinoma. Merkel cell carcinoma is an aggressive skin cancer. The addition of adjuvant radiotherapy markedly improves regional control rates and should be considered best practice. [ABSTRACT FROM AUTHOR]

Summary Leptomeningeal carcinomatosis is an uncommon but devastating form of metastatic spread. To our knowledge, only 16 cases originating from a head and neck cancer have been reported. We describe the first case of a patient with leptomeningeal carcinomatosis arising from a laryngeal squamous cell carcinoma. Shortly after completing treatment for an advanced supraglottic laryngeal cancer, this 63-year-old man presented with lower limb neurological symptoms and signs. Radiological and cytological evidence of leptomeningeal carcinomatosis of the distal spinal canal was identified. He was treated with intrathecal methotrexate and palliative radiotherapy. Although his pain improved, his lower limb weakness worsened. He died 3 weeks after completing radiotherapy. Presumed mode of spread was via the haematogenous route. The natural history and management of leptomeningeal carcinomatosis are discussed. Clinicians should be aware of the uncommon possibility of leptomeningeal carcinomatosis in a patient presenting with an appropriate constellation of symptoms and signs, and a past history of cancer. [ABSTRACT FROM AUTHOR]

Background: Australia has the highest incidence of cutaneous squamous cell carcinoma in the world. The majority of lesions occur in the head and neck with metastases to the parotid gland lymph nodes reflecting an uncommon, but aggressive, manifestation. Parotidectomy ± neck dissection followed by adjuvant radiotherapy should be considered as best practice. Methods: Between 1983 and 2000, seventy-four patients were treated for metastatic cutaneous squamous cell carcinoma to the parotid with surgery and adjuvant radiotherapy at Westmead Hospital, Sydney. Relevant data were extracted from patient files and a prospectively maintained database. Patterns of relapse and outcome were analysed. Results: Median age at diagnosis was 65 years (34-93 years) in 63 men and 11 women. Median follow-up duration was 41 months (12-188 months). All patients underwent parotidectomy with 52 undergoing a simultaneous neck dissection. Twelve patients required sacrifice of the facial nerve (4) or one or more branches (8). All received adjuvant radiotherapy to the parotid region with 56 also receiving radiotherapy to the ipsilateral neck. Despite treatment, 24% developed locoregional recurrence, with a median time to relapse of 7.5 months. The most common site for recurrence was the treated parotid region and upper neck. Most relapsed patients died. No variable independently predicted for locoregional recurrence on multivariate analysis. The 5-year absolute and cause-specific survival rates were 58% and 72%, respectively. Conclusion: Parotid gland lymph node metastases from cutaneous squamous cell carcinoma are associated with a high rate of recurrence and cause-specific mortality despite current best practice (surgery and high dose adjuvant radiotherapy). The role of more aggressive surgery, altered fractionation or chemotherapy to enhance locoregional control remains unclear. [ABSTRACT FROM AUTHOR]

Background: The treatment of squamous cell carcinoma of the lip with surgery is usually curative but incomplete/inadequate excision may be associated with recurrence and poor outcome. There is no consensus in the literature on the definition of an adequate excision margin. Methods: Patients treated for squamous cell carcinoma of the lip at Westmead Hospital, Sydney, between 1980 and 2000 were eligible for inclusion. Polytomous logistic regression analysis was undertaken to assess for predictors of recurrence. Recurrence-free and overall survival were calculated using Kaplan-Meier survival curves. Results: A total of 130 patients was identified. Median age at diagnosis was 64 years (23-97 years). Most lesions (90%) were located on the lower lip in 96 (74%) male patients. Median follow-up duration was 54 months (0-189 months). Most patients ­presented with T1 lesions (75%). Initial treatment was surgery (39%), radiotherapy (48%) or both (13%). Twenty-seven per cent of excised lesions had a close (≤2 mm) or positive margin. A total of 40 patients (31%) had recurrence (18% lymph nodes, 11% lip and 2% both). In the surgery group recurrence was significantly more likely with close or positive margins (P = 0.05). The 2 year ­recurrence-free survival was 82% and 54% for radiotherapy and surgery, respectively (P < 0.001). The 2 year overall survival was similar (90% radiotherapy vs 100% surgery; P = 0.58). Conclusion: Incomplete or inadequate excision of some lip cancers results in local recurrence. If re-excision is not feasible ­surgeons should consider the role of adjuvant radiotherapy in improving local control. [ABSTRACT FROM AUTHOR]