Risk stratification for metastasis from cutaneous squamous cell carcinoma of the head and neck
- Resource Type
- Academic Journal
- Authors
- Peat, Bruce; Insull, Phillip; Ayers, Rebecca
- Source
- ANZ Journal of Surgery. Apr 01, 2012 82(4):230-233
- Subject
- Language
- English
- ISSN
- 1445-1433
BACKGROUND:: The purpose of the study was to develop a system of risk stratification, based on clinical and histological factors that would aid prediction of metastasis from cutaneous squamous cell carcinoma (SCC) of the head and neck. METHOD:: The method used was a retrospective case control study comparing clinical and histological parameters of 78 patients who developed metastasis with 92 patients who did not develop metastasis over a 5-year period. RESULTS:: The two ‘absolute’ (highest) risk factors for development of metastatic disease are poor histological differentiation and perineural/lymphovascular infiltration. The three ‘relative’ risk factors are moderate histological differentiation, diameter ≥20 mm and Clark level 5. RISK STRATIFICATION:: High-risk lesions have either one of the absolute risk factors or all three of the relative risk factors with a predicted incidence of metastasis of 37%. Intermediate risk lesions have two of three relative risk factors and a predicted incidence of metastasis of 5%. Low-risk lesions have one or none of the relative risk factors and a predicted incidence of meatstasis of 0.3%. CONCLUSION:: Ongoing management of patients with histo-pathologically proven invasive SCC of the head and neck should be based upon risk stratification for metastasis.