Regional Lymph Node Metastasis in Sebaceous Carcinoma of the Head and Neck: A Systematic Review and Meta-Analysis

Background/Objectives: Sebaceous carcinoma (SC) is a rare and aggressive malignancy most often arising in the head and neck. The reported rate of lymph node metastasis is variable and current clinical guidelines surrounding pre-treatment imaging and management of lymph nodes are not well defined. The aim of our systematic review and meta-analysis was to determine a pooled rate of clinically apparent and occult lymph node metastases for SC of the head and neck to inform clinical guidelines. Methods: Per PRISMA guidelines, systematic search of the Pubmed/MEDLINE and EMBASE databases identified studies published before October 2023 reporting regional lymph node status in adults with SC of the head and neck. Meta analysis using the random-effects model was applied to calculate the pooled proportion of subjects with lymph node metastasis. Clinical characteristics of subjects were further analyzed using chi square tests and univariate logistic regression. Results: Thirty-eight studies met inclusion criteria with a total of 2371 patients. The pooled prevalence of regional lymph node involvement, including clinically apparent and occult disease, was 16% (95% CI 13-18%, I² 65%), with increased risk with increasing T stage. The pooled rate of occult lymph node metastases was 7% (95% CI 4-9%, I² 68%). Conclusions: There is a high rate of lymph node involvement in SC of the head and neck, much of which goes undetected during initial workup and treatment. Initial workup should reflect this risk and include appropriate physical exam, imaging, consideration for sentinel lymph node biopsy, and involvement of a multi-disciplinary team.