Metastatic head and neck cutaneous squamous cell carcinoma: Defining a low-risk patient

Background The purpose of this study was to determine whether there is a low-risk subset of patients with regional metastatic head and neck cutaneous squamous cell carcinoma (SCC) suitable for treatment with surgery alone and omission of adjuvant radiotherapy. Methods. We conducted a retrospective analysis of 168 patients with a single parotid gland or neck nodal metastasis <= 3 cm in size from cutaneous SCC treated with curative intent by surgery +/- adjuvant radiotherapy. Results. Disease-specific survival for the 33 patients treated with surgery alone was 97% at 5 years. In the subset of 19 patients without extracapsular nodal spread (ECS), there was 1 regional recurrence which was successfully salvaged yielding a 5-year disease-specific survival of 100%. Conclusion. In head and neck cutaneous SCC, the subset with a single node <= 3 cm in size without ECS are at low risk of regional failure and death from cutaneous cancer. These patients may be suitable for single-modality therapy with surgery alone. (C) 2011 Wiley Periodicals, Inc. Head Neck 34: 365-370, 2012