Lymph node metastases from auricular squamous cell carcinoma. A systematic review and meta-analysis

Area of Science:

• Oncology
• Dermatology
• Head and Neck Surgery

Background:

• Squamous cell carcinoma (SCC) of the auricle demonstrates a higher propensity for regional lymph node metastasis compared to SCC at other anatomical sites.
• Metastatic spread from auricular SCC is linked to poorer patient prognosis, yet effective risk stratification and treatment strategies remain undefined.

Purpose of the Study:

• To systematically review the literature on the metastatic patterns and risk factors associated with squamous cell carcinoma of the auricle.
• To inform clinical decision-making regarding the identification and management of patients at risk for metastasis.

Main Methods:

• A comprehensive systematic review of the Medline and Embase databases was performed.
• Cross-referencing of relevant articles was utilized to maximize study inclusion.

Main Results:

• The overall metastatic rate for auricular SCC was found to be 11.2%.
• Metastases most commonly involved the parotid and upper deep cervical lymph nodes.
• The majority of metastases (85%) developed within 12 months, and 98% within 24 months.
• Tumor depth, size, differentiation, and incomplete excision margins are potential indicators for metastatic risk, though evidence is insufficient for routine targeted neck dissections.
• Mortality occurred in 6.2% of cases, often due to failures in loco-regional control.

Conclusions:

• Auricular SCC has a significant risk of regional metastasis, predominantly to the parotid and upper cervical lymph nodes.
• While certain tumor characteristics may indicate higher risk, current evidence does not support routine targeted neck dissections.
• Further research is needed to establish clear guidelines for risk assessment and management of metastatic auricular SCC.