Brief Article
Copyright ©2013 Baishideng. All rights reserved.
World J Otorhinolaryngol. Feb 28, 2013; 3(1): 16-21
Published online Feb 28, 2013. doi: 10.5319/wjo.v3.i1.16
Elective regional lymphadenectomy for advanced auricular squamous cell carcinoma
William R Ryan, Chase M Heaton, Steven J Wang
William R Ryan, Chase M Heaton, Steven J Wang, Division of Head and Neck Surgery, Department of Otolaryngology, University of California, San Francisco, CA 94115, United States
Author contributions: All authors were involved in data gathering, data synthesis, and manuscript preparation.
Correspondence to: Chase M Heaton, MD, Division of Head and Neck Surgery, Department of Otolaryngology, University of California, San Francisco, CA 94115, United States.
Telephone: +1-650-3876807 Fax: +1-415-8857171
Received: May 11, 2012
Revised: November 14, 2012
Accepted: December 1, 2012
Published online: February 28, 2013

AIM: To investigate the rate of occult lymph node disease in elective parotidectomy and neck dissection specimens in patients with advanced auricular cutaneous squamous cell carcinoma (cSCC).

METHODS: At a single institution, from 2000 to 2010, 17 patients with advanced auricular cSCC were considered high risk for occult regional parotid and/or neck nodal metastases and, thus, underwent an auriculectomy and elective regional lymphadenectomy (parotidectomy and/or neck dissection). Indications for elective regional lymphadenectomy were large tumor size, locally invasive tumors, post-surgical and post-radiation recurrence, and being an immunosuppressed patient. We determined the presence of microscopic disease in the regional (parotid and neck dissection) pathology specimens.

RESULTS: There were 17 advanced auricular cSCC patients analyzed for this study. Fifteen (88%) patients were men. The average age was 69 (range: 33 to 86). Ten (59%) patients presented with post-surgical recurrence. Five (29%) patients presented with post-radiation recurrence. Four (24%) patients presented with both post-surgical and post-radiation recurrence. Four (24%) patients were immunosuppressed (2 (12%) were liver transplant patients, 2 (12%) were chronic lymphocytic leukemia patients, and 1 (6%) was both). 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 auricular cSCC. No patients had bilateral disease. All patients were confirmed to have cSCC on final pathology. The tumors were well (5, 29%), moderately (10, 59%), and poorly (2, 12%) differentiated SCC. The average size of the cSCC tumor was 2.9 cm (range: 1.7 to 7 cm). Twelve (70%) tumors were greater than 2 cm. Six (35%) patients underwent partial auriculectomy. Eleven (65%) patients underwent total auriculectomy. Eight (47%) patients underwent elective parotidectomy and elective neck dissections; 3 (18%) underwent only elective parotidectomy; 3 (18%) underwent only an elective neck dissection; 2 (12%) underwent an elective parotidectomy and therapeutic neck dissection; and 1 (6%) underwent a therapeutic parotidectomy and an elective neck dissection. None of the elective parotidectomy or neck dissection specimens were found to contain any malignant disease. All therapeutic parotidectomy and neck 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%), levels II/III/Va (2, 14%), levels I/II/III/Va (2, 14%), and complete levels I-V (9, 64%)]. Three (18%) underwent concurrent temporal bone resections for tumor extension from the auricle. The average follow-up for our patients was 44 mo (range: 4 to 123 mo). At the time of the review, 6 (35%) patients were alive and 11 (65%) had passed away.

CONCLUSION: This study suggests that, in patients with advanced auricular cutaneous SCC, elective regional lymphadenectomy is not necessary. However, furtherprospective studies are necessary to assess the necessity.

Keywords: Advanced auricular squamous cell carcinoma, Elective lymphadenectomy, Elective parotidectomy, Elective neck dissection, Occult regional metastases