摘要:AIM To investigate the rate of occult lymph nodedisease in elective parotidectomy and neck dissectionspecimens in patients with advanced auricular cutaneoussquamous cell carcinoma (cSCC).METHODS: At a single institution, from 2000 to 2010,17 patients with advanced auricular cSCC were consideredhigh risk for occult regional parotid and/or necknodal metastases and, thus, underwent an auriculectomyand elective regional lymphadenectomy (parotidectomyand/or neck dissection). Indications for electiveregional lymphadenectomy were large tumor size,locally invasive tumors, post-surgical and post-radiationrecurrence, and being an immunosuppressed patient.We determined the presence of microscopic disease inthe regional (parotid and neck dissection) pathologyspecimens.RESULTS: There were 17 advanced auricular cSCCpatients analyzed for this study. Fifteen (88%) patientswere men. The average age was 69 (range: 33 to 86).Ten (59%) patients presented with post-surgical recurrence.Five (29%) patients presented with postradiationrecurrence. Four (24%) patients presentedwith both post-surgical and post-radiation recurrence.Four (24%) patients were immunosuppressed (2(12%) were liver transplant patients, 2 (12%) werechronic lymphocytic leukemia patients, and 1 (6%) wasboth). The subsite distribution of cSCC included helix(3, 18%), antihelix (2, 12%), conchal bowl (7, 41%),tragus (2, 12%), and postauricular sulcus (3, 18%).Four (24%) patients presented with multifocal auricularcSCC. No patients had bilateral disease. All patientswere confirmed to have cSCC on final pathology. Thetumors were well (5, 29%), moderately (10, 59%), andpoorly (2, 12%) differentiated SCC. The average size ofthe cSCC tumor was 2.9 cm (range: 1.7 to 7 cm). Twelve(70%) tumors were greater than 2 cm. Six (35%) patientsunderwent partial auriculectomy. Eleven (65%)patients underwent total auriculectomy. Eight (47%)patients underwent elective parotidectomy and electiveneck dissections; 3 (18%) underwent only electiveparotidectomy; 3 (18%) underwent only an electiveneck dissection; 2 (12%) underwent an elective parotidectomyand therapeutic neck dissection; and 1 (6%)underwent a therapeutic parotidectomy and an electiveneck dissection. None of the elective parotidectomy orneck dissection specimens were found to contain anymalignant disease. All therapeutic parotidectomy andneck dissection specimens contained metastatic SCC.Fourteen (82%) underwent parotidectomy. Of these, 10(71%) underwent superficial parotidectomy whereas 4(29%) underwent total parotidectomy. Fourteen (82%)underwent neck dissections [levels Ⅱ/Ⅴa (1, 7%), levelsⅡ/Ⅲ/Ⅴa (2, 14%), levels Ⅰ/Ⅱ/Ⅲ/Ⅴa (2, 14%), andcomplete levels Ⅰ-Ⅴ (9, 64%)]. Three (18%) underwentconcurrent temporal bone resections for tumor extensionfrom the auricle. The average follow-up for ourpatients was 44 mo (range: 4 to 123 mo). At the timeof the review, 6 (35%) patients were alive and 11 (65%)had passed away.CONCLUSION: This study suggests that, in patientswith advanced auricular cutaneous SCC, elective regionallymphadenectomy is not necessary. However,furtherprospective studies are necessary to assess thenecessity.