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Patterns of regional metastasis in advanced stage cutaneous squamous cell carcinoma of the auricle
Nicholas Peiffer1, J Walter Kutz, Larry L Myers
1Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9035, USA.
Objective:
To determine patterns of regional metastasis in patients with advanced stage cutaneous squamous cell carcinoma of the auricle.
Study Design:
Case series with chart review.
Setting:
University-based tertiary care hospitals.
Subjects And Methods:
We analyzed 41 patients with stage III and IV squamous cell carcinoma of the auricle.
Results:
The mean age was 74.2 years (range, 20.6-91.7 years). Thirty-five patients (85.4%) were stage IV. Twenty-nine patients (70.7%) had a prior history of nonauricular, nonmelanotic skin carcinoma. Twenty-four patients (58.5%) had regional metastasis to either the cervical or parotid nodal basin. In patients with cervical metastasis, the involvement by level was 6.7% (n = 1), 80.0% (n = 12), 46.6% (n = 7), 13.3% (n = 2), and 40.0% (n = 6), respectively. Of the 6 patients with a level 5 metastasis, 3 had primaries in the preauricular region, 2 had primaries of the auricle, and 1 had a primary of the postauricular region. Occult disease was present in 2 patients (9.1%) with cervical metastasis and in 4 patients (18.2%) with periparotid lymph node metastasis. Perineural invasion was seen in 84.4% of the study population. The recurrence rate was 46.3% (n = 19). The median time to recurrence was 28.3 months.
Conclusion:
Patients with advanced stage auricular cutaneous squamous cell carcinoma have a high rate of regional metastasis and recurrence. When planning neck dissections for these patients, level 5 should be included in the resection. Patients demonstrating locally advanced disease without clinical or radiographic evidence of metastasis to the parotid or cervical drainage basin should undergo a parotidectomy and comprehensive neck dissection.
