Shires Courtney B, Boughter John D, Golembeski Christopher P, Sharp Nicholas M, Hall Arabella T, Sebelik Merry E
West Cancer Center, Germantown, TN, USA.
Department of Neuroanatomy, University of Tennessee, Memphis, TN, USA.
Arch Dermatol Res. 2025 Apr 12;317(1):703. doi: 10.1007/s00403-025-04224-9.
CSCC (cutaneous squamous cell carcinoma) of the face/scalp generally has a favorable outcome. However, patients with delayed regional metastasis from scalp/facial CSCC do very poorly. Historically, prophylactic treatment of the N0 neck for the T1-T2 (as staged in the AJCC 7th edition) face/scalp cancers has not been recommended. This study aims to determine predictors of delayed regional metastases in < 4 cm CSCC of the face and scalp.
We retrospectively analyzed medical records of patients diagnosed regional metastasis of CSCC of the scalp/face at least 6 months after the diagnosis of the primary CSCC at a tertiary academic head and neck clinic during a period between 2012 and 2018.
A total of 50 patients with CSCC of the face/scalp were diagnosed and treated for delayed cervical lymph node metastasis during a 6-year period. All patients were male. Areas affected were the scalp, cheeks, and forehead. No patient had neck lymph node metastases at initial presentation for their scalp/face cancer. The presence of perineural invasion in the primary tumor was the only observed predictor of delayed neck lymph node recurrence. We did not observe an association between diameter/depth of the primary skin tumor or lymphovascular invasion and the presence of regional lymph node recurrence.
In our review, perineural invasion (PNI) was the one factor predictive of delayed regional lymph node metastasis. This observation confirms the use of PNI to upstage even small CSCC to T3. Prophylactic treatment of the neck in patients with small scalp/face cancers with PNI should be strongly considered, especially in the age of immunotherapy.
面部/头皮皮肤鳞状细胞癌（CSCC）通常预后良好。然而，头皮/面部CSCC出现区域转移延迟的患者预后很差。从历史上看，对于T1 - T2期（依据美国癌症联合委员会第7版分期）的面部/头皮癌，不建议对N0颈部进行预防性治疗。本研究旨在确定面部和头皮<4 cm CSCC区域转移延迟的预测因素。
我们回顾性分析了2012年至2018年期间在一家三级学术头颈诊所诊断为原发性CSCC后至少6个月被诊断为头皮/面部CSCC区域转移的患者的病历。
在6年期间，共有50例面部/头皮CSCC患者被诊断并接受了颈部淋巴结转移延迟的治疗。所有患者均为男性。受累部位为头皮、脸颊和前额。所有患者在初次诊断头皮/面部癌时均无颈部淋巴结转移。原发肿瘤中存在神经周围侵犯是观察到的唯一预测颈部淋巴结复发延迟的因素。我们未观察到原发性皮肤肿瘤的直径/深度或淋巴管侵犯与区域淋巴结复发之间存在关联。
在我们的综述中，神经周围侵犯（PNI）是预测区域淋巴结转移延迟的一个因素。这一观察结果证实了即使是小的CSCC，若存在PNI也应将其分期上调至T3。对于有PNI的小头皮/面部癌患者，应强烈考虑对颈部进行预防性治疗，尤其是在免疫治疗时代。
