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Carta F, Corrias S, Tatti M, Marrosu V, Bontempi M, Mariani C, Gerosa C, Ferreli C, Atzeni M, Boriani F, Figus A, Puxeddu R. Surgical Management of Patients with Parotid Involvement from Non-Melanoma Skin Cancer of the Head and Neck. J Pers Med 2024; 14:631. [PMID: 38929852 PMCID: PMC11204643 DOI: 10.3390/jpm14060631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/04/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024] Open
Abstract
We conducted a retrospective, longitudinal study on a single-center series of patients who underwent parotidectomy in the management of advanced head and neck non-melanoma skin cancer (hnNMSC). The aim of this study was to identify prognostic factors associated with worse outcomes. Forty-one men and nine women were included. The mean age at the time of surgery was 78.9 years. The 5-year overall survival, disease-specific survival, locoregional recurrence-free survival, and distant metastasis-free survival calculated with Kaplan-Meier curves were 39.9%, 56.3%, 58.6%, and 82.1%, respectively. A univariate analysis showed that the status of the margins, facial nerve direct involvement, lymph vascular invasion, and histological grading were associated with worse outcomes (p < 0.05). Positive margins were associated with worse disease-specific survival also in a multivariate analysis (p = 0.001, HR = 32.02, and CIs 4.338 to 351.3). Because the resection in free margins is the most important prognostic factor, early diagnosis or, in the case of advanced disease, extensive surgical resection with concomitant reconstruction is needed. Adjuvant therapy is indicated in selected cases.
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Affiliation(s)
- Filippo Carta
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy; (S.C.); (M.T.); (V.M.); (M.B.); (C.M.); (R.P.)
| | - Simone Corrias
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy; (S.C.); (M.T.); (V.M.); (M.B.); (C.M.); (R.P.)
| | - Melania Tatti
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy; (S.C.); (M.T.); (V.M.); (M.B.); (C.M.); (R.P.)
| | - Valeria Marrosu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy; (S.C.); (M.T.); (V.M.); (M.B.); (C.M.); (R.P.)
| | - Mauro Bontempi
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy; (S.C.); (M.T.); (V.M.); (M.B.); (C.M.); (R.P.)
| | - Cinzia Mariani
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy; (S.C.); (M.T.); (V.M.); (M.B.); (C.M.); (R.P.)
| | - Clara Gerosa
- Unit of Pathology, Department of Medical Sciences and Public Health, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy;
| | - Caterina Ferreli
- Unit of Dermatology, Department of Medical Sciences, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy;
| | - Matteo Atzeni
- Unit of Plastic Surgery, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy; (M.A.); (F.B.); (A.F.)
| | - Filippo Boriani
- Unit of Plastic Surgery, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy; (M.A.); (F.B.); (A.F.)
| | - Andrea Figus
- Unit of Plastic Surgery, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy; (M.A.); (F.B.); (A.F.)
| | - Roberto Puxeddu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy; (S.C.); (M.T.); (V.M.); (M.B.); (C.M.); (R.P.)
- Unit of Otorhinolaryngology, Department of Surgery, King’s College Hospital London-Dubai, Dubai P.O. Box 340901, United Arab Emirates
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Rampinelli V, Pinacoli A, Piazza C. Head and neck nonmelanoma skin cancers: surgical management and debated issues. Curr Opin Otolaryngol Head Neck Surg 2024; 32:62-70. [PMID: 38193646 PMCID: PMC10919275 DOI: 10.1097/moo.0000000000000960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW This review critically assesses the current literature and guidelines, aiming to clarify some of the most important factors that impact surgical strategies of head and neck nonmelanoma skin cancers (NMSCs), focusing on squamous, basal, and Merkel cell carcinomas. RECENT FINDINGS Recent developments underscore the complexity of treatment for NMSC, particularly in the head and neck region. There is a lack of high-level evidence for the management of these tumors, especially in advanced stages. The need to tailor the extent of surgical margins and parotid/neck management to different histotypes, considering the varying risk factors for recurrence, is beginning to emerge in the literature. Moreover, the role of immunotherapy and targeted therapies for locally advanced disease, alongside traditional treatment options, is progressively growing. SUMMARY NMSCs represent a heterogeneous group of malignancies with varying treatment complexities and prognoses. Management of NMSC is evolving towards an increasingly personalized strategy within a multidisciplinary therapeutic framework.
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Affiliation(s)
- Vittorio Rampinelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili, Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
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Xu N, Sun Q. Neck management in metastatic cutaneous squamous cell carcinoma of the head and neck. Front Oncol 2024; 14:1344115. [PMID: 38487725 PMCID: PMC10937539 DOI: 10.3389/fonc.2024.1344115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
Objective Optimal neck management remains unclear in head and neck cutaneous squamous cell carcinoma (HNcSCC) with parotid metastasis. Our goal was to compare the impact of different cervical treatments on HNcSCC with parotid metastasis. Methods Patients were retrospectively included. The primary outcome variables were regional control (RC) and disease-specific survival (DSS). The impacts of observation, elective neck irradiation (ENI), and elective neck dissection (END) were analyzed using the Cox model and presented as hazard ratios (HRs) and 95% confidence intervals (CIs). Results In total, 268 patients were enrolled. In the Cox model for RC, compared with ENI, observation was associated with a significantly higher risk of regional recurrence (p = 0.001, HR = 2.50, 95%CI = 1.45-4.30). However, END showed a comparable influence on regional recurrence (p = 0.246, HR = 0.70, 95%CI = 0.38-1.28). In the Cox model for DSS, END demonstrated a similar HR of 0.62 (95%CI = 0.30-1.26) compared to ENI (p = 0.184). However, patients who underwent observation were associated with an additional nearly twofold risk of cancer-related mortality (HR = 2.85, 95%CI = 1.55-5.23). Subgroup analysis showed that ENI predicted comparable RC (p = 0.389) and DSS (p = 0.346) in patients with one or two metastatic parotid lymph nodes, but worse RC (p = 0.007) and DSS (p = 0.024) in patients with more than three positive lymph nodes. Conclusion In HNcSCC with parotid metastasis, elective treatment of neck lymph nodes with END or ENI should always be performed.
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Affiliation(s)
- Ning Xu
- Special Clinic, Henan Provincial Stomatological Hospital, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiang Sun
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Mittal A, Mittal BB. Comparative Analysis of US Guidelines for the Management of Cutaneous Squamous Cell and Basal Cell Carcinoma. J Skin Cancer 2024; 2024:3859066. [PMID: 38370137 PMCID: PMC10872771 DOI: 10.1155/2024/3859066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/11/2024] [Accepted: 01/22/2024] [Indexed: 02/20/2024] Open
Abstract
Background This study presents a comparative analysis of recently published guidelines to manage cutaneous squamous cell carcinoma (cSCC) and cutaneous basal cell carcinoma (cBCC) within the United States (US). Methods A PubMed database search was performed for the time period between June 1, 2016, and December 1, 2022. A comprehensive comparison was performed in the following clinical interest areas: staging and risk stratification, management of primary tumor and regional nodes with curative intent, and palliative treatment. Results Guidelines from 3 organizations were analyzed: the American Academy of Dermatology (AAD), the National Comprehensive Cancer Network (NCCN), and the American Society for Radiation Oncology (ASTRO). The guidelines used different methodologies to grade evidence, making comparison difficult. There was agreement that surgery is the preferred treatment for curative cBCC and cSCC. For patients ineligible for surgery, there was a consensus to recommend definitive radiation. AAD and NCCN recommended consideration of other topical modalities in selected low-risk cBCC. Postoperative radiation therapy (PORT) was uniformly recommended in patients with positive margins that could not be cleared with surgery and in patients with nerve invasion. The definition and extent of nerve invasion varied. All guidelines recommended surgery as the primary treatment in patients with lymph node metastases in a curative setting. The criteria used for PORT varied; NCCN and ASTRO used lymph node size, number of nodes, and extracapsular extension for recommending PORT. Both NCCN and ASTRO recommend consideration of systemic treatment along with PORT in patients with extracapsular extension. Conclusion: US guidelines provide contemporary and complementary information on the management of cBCC and cSCC. There are opportunities for research, particularly in the areas of staging, indications for adjuvant treatment in curative settings, extent of nerve invasion and prognosis, and the role of systemic treatments in curative and palliative settings.
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Affiliation(s)
- Amit Mittal
- Department of Dermatology, Mayo Clinic College of Medicine & Science, 200 First St SW, Rochester, MN 55905, USA
| | - Bharat B. Mittal
- Department of Radiation Oncology, Northwestern University, 251 E Huron LC-178, Chicago, IL 60611, USA
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Civantos F, Helmen ZM, Bradley PJ, Coca-Pelaz A, De Bree R, Guntinas-Lichius O, Kowalski LP, López F, Mäkitie AA, Rinaldo A, Robbins KT, Rodrigo JP, Takes RP, Ferlito A. Lymph Node Metastases from Non-Melanoma Skin Cancer of the Head and Neck. Cancers (Basel) 2023; 15:4201. [PMID: 37686478 PMCID: PMC10486745 DOI: 10.3390/cancers15174201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 09/10/2023] Open
Abstract
Non-melanoma skin cancer (NMSC) represents the most common malignancy in the world, comprising exceedingly common lesions such as basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) and rare lesions such as Merkel cell carcinoma. Risk factors are widely recognized and include ultraviolet (UV) light exposure, radiation exposure, immunosuppression, and many others. As a whole, survival and functional outcomes are favorable, but each histopathological subtype of NMSC behaves differently. Treatment regimens for the primary site usually include wide surgical excision and neck dissection in cases of clinically involved metastatic lymph nodes. The elective management of draining nodal basins, however, is a contested topic. Nearly all subtypes, excluding BCC, have a significant risk of lymphatic metastases, and have been studied with regard to sentinel lymph node biopsy (SLNB) and elective neck dissection. To date, no studies have definitively established a true single standard of care, as exists for melanoma, for any of the NMSCs. As a result, the authors have sought to summarize the current literature and identify indications and management options for the management of the cervical lymphatics for each major subtype of NMSC. Further research remains critically necessary in order to develop complete treatment algorithms.
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Affiliation(s)
- Francisco Civantos
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (F.C.); (Z.M.H.)
| | - Zachary M. Helmen
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (F.C.); (Z.M.H.)
| | - Patrick J. Bradley
- Department of Otorhinolaryngology-Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham NG7 2UH, UK
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain; (A.C.-P.); (F.L.)
| | - Remco De Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, 07747 Jena, Germany
| | - Luiz P. Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paolo 01509-900, Brazil
- Head and Neck Surgery Department, University of São Paulo Medical School, Sao Paulo 05403-000, Brazil
| | - Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain; (A.C.-P.); (F.L.)
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, FI-00029 HUS Helsinki, Finland;
| | | | - K. Thomas Robbins
- Department of Otolaryngology Head and Neck Surgery, School of Medicine, Southern Illinois University Carbondale, Carbondale, IL 62901, USA
| | - Juan P. Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain; (A.C.-P.); (F.L.)
| | - Robert P. Takes
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35100 Padua, Italy
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Costantino A, Canali L, Festa BM, Spriano G, Mercante G, De Virgilio A. Sentinel lymph node biopsy in high-risk cutaneous squamous cell carcinoma of the head and neck: Systematic review and meta-analysis. Head Neck 2022; 44:2288-2300. [PMID: 35713173 DOI: 10.1002/hed.27121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/11/2022] [Accepted: 06/01/2022] [Indexed: 11/07/2022] Open
Abstract
The aim of our study was to better define the role of sentinel lymph node biopsy (SLNB) in high-risk cutaneous squamous cell carcinoma of the head and neck (cSCCHN). A systematic review and meta-analysis was performed according to the PRISMA statement. Seven-hundred and five patients were included from 20 studies. The pooled SLN identification rate was 98.8% (95%CI: 97.0-99.8). The median number of SLN excised was 3.6 (n = 371, 95%CI: 2.0-4.4). The pooled SLNB positive rate and cumulative regional recurrence rate (RRR) in negative SLNB were 5.6% (95%CI: 2.6-9.6) and 2.9% (95%CI: 0.5-7.2), respectively. The high SLN identification rate demonstrates SLNB feasibility in cSCCHN. The low SLNB positive rate and the relatively high RRR raise some doubts concerning its clinical utility. Further studies are mandatory to define predictors of lymph node metastases able to better select patients that may benefit from a SLNB.
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Affiliation(s)
- Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Luca Canali
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Bianca Maria Festa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
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