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Management of Nodal Metastases

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High-Risk Cutaneous Squamous Cell Carcinoma

Abstract

In most patients with a cutaneous squamous cell carcinoma (cSCC) local treatment is curative. However, a subset of patients will develop nodal metastases to draining regional lymph nodes. Most cSCC arise on the sun-exposed head and neck (HN) and subsequently the parotid and cervical nodes are the most frequent sites for the development of nodal metastases. Less frequently encountered are metastatic nodes involving the axilla or groin arising from primary tumors of the trunk or extremities. Mortality associated with cSCC is usually a consequence of uncontrolled metastatic nodal disease since distant metastases are rare. Thus, optimal treatment of nodal disease is crucial to minimizing cSCC mortality. Patients with operable nodal disease have traditionally been recommended surgery. The efficacy of adjuvant radiotherapy (RT) has previously been questioned based on weak evidence in the early literature. However contemporary evidence from larger studies has strengthened the role of adjuvant RT as an efficacious means to improve regional control and survival. Despite this, many patients still experience relapse and die. Research aimed at improving outcomes including a randomized trial incorporating the addition of chemotherapy to adjuvant RT is currently in progress in Australia and New Zealand. Meanwhile, current best practice in the majority of operable patients with nodally metastatic cSCC is surgery followed by adjuvant RT.

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Author information

Authors and Affiliations

  1. Westmead Cancer Care Center, Westmead Hospital, Hawkesbury Road, Sydney, NSW, 2145, Australia

    Michael Veness MB, BS, MD (USyd), FRANZCR

  2. Department of Surgery, Westmead Hospital, Hawkesbury Road, Sydney, NSW, 2145, Australia

    Julie Howle BSc, MBBS, MS, FRACS, FACS

Authors
  1. Michael Veness MB, BS, MD (USyd), FRANZCR
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  2. Julie Howle BSc, MBBS, MS, FRACS, FACS
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Corresponding author

Correspondence to Michael Veness MB, BS, MD (USyd), FRANZCR .

Editor information

Editors and Affiliations

  1. Brigham & Women's Hosp., Dept of Derm., Mohs & Dermatologic Surgery Center, Jamaica Plain, Massachusetts, USA

    Chrysalyne D. Schmults

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Veness, M., Howle, J. (2016). Management of Nodal Metastases. In: Schmults, C. (eds) High-Risk Cutaneous Squamous Cell Carcinoma. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-47081-7_8

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  • DOI: https://doi.org/10.1007/978-3-662-47081-7_8

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-47080-0

  • Online ISBN: 978-3-662-47081-7

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