Elective regional lymphadenectomy for advanced auricular squamous cell carcinoma

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.