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PubMed2001

[The study on the occult metastases to cervical lymph node in squamous cell carcinoma of the larynx and hypopharynx].

OBJECTIVE: To study the metastastic regularity of cervical lymph node in squamous cell carcinoma of the larynx and hypopharynx, which will provide some theoretical basis for surgeon to use selective neck dissection (SND) in some patients with carcinoma above. METHOD: Sixty-nine originally cN0 staged neck dissection specimens from 40 patients were evaluated using mutipl-level sectioning in 4 microns intervals, which were respectively processed by H&E-staining and immunostaining with an antibody to cytokeratin (CK AE3). These patients weren't given any treatment (radiotherapy or chemotherapy or surgery in neck) before surgery. All cases had been followed up 1 year or more. RESULT: The examination of lymph nodes from 40 patients revealed 31 (0.59% 31/2219) occult metastases in 14 (35% 14/40) patients. Among them, six patients with supraglottic cancer, 1 patient with transglottic cancer and 7 patients with hypopharyngeal cancer. There were no occult metastases to cervical lymph node among 9 patients with glottic cancer. All occult metastases mainly located in ipsilateral level II and/or level III. Occult metastases weren't found in nodes from level I, level IV and level V. CONCLUSION: The study further prove that metastases to cervical lymph node mainly occur in the ipsilateral level II and level III among patients with carcinoma of the larynx and hypopharynx. According to the risks of occurring occult metastases to cervical lymph node, we suggest applying to ipsilateral or bilateral SND (level II and level III be dissected) among patients with carcinoma of the larynx and hypopharynx which staged T2-T4 N0M0 clinically.

Adult↗
PubMed1981

CT of cervical lymph node cancer.

This study seeks to establish whether CT can accurately detect cancer in cervical lymph nodes. Retrospective correlation of CT scans and surgical findings in 51 patients with laryngeal cancer undergoing radical neck dissection suggested that the node-bearing areas in the neck can be usefully evaluated with CT scans. An additional 10 patients studied prospectively with carefully correlated CT scans and radical neck dissections were used to evaluate CT specific criteria for cancer in individual nodes. In 13 patients CT correctly predicted surgically confirmed nonpalpable nodal metastases in six. It suggested false-positive nodes in two. These criteria are now being tested in an ongoing evaluation of the clinical value of CT in the management of head and neck tumors.

Carcinoma↗
PubMed2005

The management of squamous cell carcinoma of the neck. The Birmingham UK experience.

AIMS: To review our treatment strategy and outcomes for metastatic squamous cell carcinoma of the neck. METHODS: One hundred and six consecutive patients treated between 1992 and 1998 were analysed retrospectively. The following data were obtained. Demographic details, tumour site, clinical and pathological TMN staging, tumour grade and presence of extracapsular spread, treatment modality (surgery, radiotherapy and chemotherapy), type of neck dissection and complications, 2-year loco-regional control and 5-year overall survival. RESULTS: Ninety-two patients had advanced disease (stages 3 and 4) and of these, 57% had palpable neck metastases. One hundred and six patients underwent a total of 132 neck dissections. Seventy-three patients had post-operative radiotherapy to both sides of the neck and a total of 31 patients took part in the UKHAN 1 trial. Seventy percent of patients achieved 2-year loco-regional control and 63% survived 5-years. CONCLUSION: Metastatic squamous cell carcinoma of the neck can successfully be treated with an aggressive surgical approach and post-operative radiotherapy when indicated. Excellent 2-year loco-regional control and 5-year survival rates are possible.

Adult↗
PubMed2006

Surgical outcome of T4a and resected T4b oral cavity cancer.

BACKGROUND: The American Joint Committee on Cancer (AJCC) 2002 staging system (AJCC 2002) suggested that squamous cell carcinoma of the oral cavity (OSCC) with T4b is unresectable. The current retrospective results show that selected T4b patients were resectable with favorable outcomes. METHODS: From January 1996 to December 2000, 103 consecutive untreated T4 OSCC patients (reclassified by AJCC 2002) without carotid artery encasement and skull base extension were eligible for radical treatment. All received head-and-neck magnetic resonance imaging (MRI) and/or computed tomography (CT) scans before operation. The surgical principles were safety margins of > or =1 cm for primary tumors, modified/radical neck dissections for clinical lymph node-positive disease, and supraomohyoid neck dissection for lymph node-negative disease. In all, 95.1% of patients (98 of 103 patients) underwent free-flap reconstructions. Adjuvant radiotherapy or concomitant chemoradiotherapy was administered to those with pathological T4 (AJCC 1997), cervical lymph node metastasis, or close margins (< or =4 mm). Survivals were calculated according to the method of Kaplan and Meier. RESULTS: In all, 58 patients were classified as having T4a disease and 45 were classified as having T4b disease. No statistical difference was observed in the 5-year local control, neck control, disease-free survival, and overall survival rates between the T4a and T4b groups. In multivariate analyses, pathologic lymph node status (pN0-1 vs. pN2) was found to be the sole independent predictor for T4b for local control (P = .012), disease-free survival (P = .005), and overall survival (P = .008). CONCLUSIONS: Selected T4b OSCC patients were found to be resectable with outcomes that were comparable to those of T4a OSCC patients and may benefit from radical surgery, free-flap reconstruction, and adjuvant therapy. A pathologic lymph node status of > or =2 was found to be the sole independent predictor for T4b disease in local control and survival.

Adult↗
PubMed2002

The significance of immunohistochemically demonstrated nodal micrometastases in patients with squamous cell carcinoma of the head and neck.

OBJECTIVES/HYPOTHESIS: Patients with primary squamous cell carcinoma of the head and neck have a relatively high risk of occult lymph node metastases. Pathological demonstration of these metastases may be difficult, and the detection of such occult metastases may identify patients who are at an increased risk for early recurrence or reduced survival. Immunohistochemistry may be applied in the identification of occult metastases that may be missed on routine (H&E) histological examination. The aim of the study is to determine the prevalence and prognostic significance of immunohistochemically identified micrometastases in squamous cell carcinoma of the head and neck. STUDY DESIGN: A retrospective analysis of neck dissection specimens having no evidence of metastatic disease. METHODS: Lymph nodes from neck dissections performed on 10 patients with squamous cell carcinoma of the head and neck without conventional histological evidence of nodal metastases were subsequently stained for cytokeratins by the monoclonal antibody cocktail AE1/AE3 to detect micrometastases. RESULTS: Occult micrometastases were found in the lymph nodes 5 of 10 patients examined. There was no association between the site of primary tumor, or T tage, and the presence of occult metastases. Three of five patients found to have occult metastases developed recurrence in the neck, whereas only one of five patients with no evidence of micrometastases had regional recurrence. There was no significant discrepancy in the patient survival rate. CONCLUSIONS: Metastatic tumor cells are frequently present in lymph nodes, even in patients without histological evidence of nodal metastases by conventional methods. The presence of micrometastases may identify patients at increased risk for recurrence and may indicate poorer prognosis. The true clinical significance of these occult metastases will be determined by a long-term follow-up.

Aged↗
PubMed2003

Angiosarcoma of the larynx. Case report and review of the literature.

Angiosarcoma of the larynx is a rare malignant tumour of vascular origin, accounting for less than 1% of all malignant tumours of the larynx. Angiosarcoma involves, in particular, the head and neck in areas such as the scalp and face. The causes are unknown, even if, in some cases, it is believed to be radiation-induced. The case is described of a patient with hypopharyngolaryngeal angiosarcoma, which became manifest with dysphagia, dysphonia and a palpable right latero-cervical mass about 7 cm in length. The patient underwent total pharyngolaryngectomy, right hemithyroidectomy, and bilateral neck dissection. Histological examination of the surgical specimen revealed a large haemorrhagic lesion involving the right pyriform sinus and homolateral hemilarynx. Right radical neck dissection revealed 9 metastatic lymph nodes, 1 of which with capsular invasion. Upon complete recovery the patient, underwent adjuvant post-operative radiotherapy. Six months later she is still alive with no clinical or radiological signs of disease. A careful review of the literature produced very few reports of such cases, only 6 of which in the last 30 years. Survival rate is very low, even if feasible average can be advanced, in view of the paucity of the case reports. Histological diagnosis is not always straightforward, as this neoplasm may be misdiagnosed as other vascular tumours (Kaposi's sarcoma, haemangiopericytoma), as non-neoplastic lesions (granulomas secondary to intubation) and as poorly differentiated squamous cell carcinoma. Immunohistochemical evaluation by means of markers, such as vimentin and factor VIII, offers a significant contribution to the diagnosis of angiosarcoma. The treatment of choice for laryngeal angiosarcoma is surgical excision, ample and radical, whenever possible, followed by adjuvant post-operative radiotherapy.

Aged↗
PubMedDate not supplied

False-positive and false-negative neck nodes.

We report our experience of the incidence of false-positive (i.e., clinically positive and histologically negative) and false-negative (i.e., clinically negative and histologically positive) neck nodes and define their relationship to the primary site, T-stage, and the histologic grade of the primary lesion. Clinical and pathologic records of 255 patients with squamous cell carcinoma (SCC) of the head and neck who underwent 266 radical neck dissections were reviewed. We did not find any relationship between the T-stage of the primary tumor and the incidence of the false-positive and false-negative neck nodes. Regarding the primary site, the benefit of an elective neck dissection is likely to be maximum in oropharyngeal SCC and minimum in supraglottic SCC. The incidence of false-negative neck nodes was lower in well differentiated primary lesions.

Carcinoma, Squamous Cell↗
PubMed2002

[The sentinel node concept in head and neck squamous cell carcinoma--a critical analysis in 100 patients].

BACKGROUND: The value of Sentinel Node (SN) concept is a current issue in clinical oncology. Few investigations deal with SN biopsy in head and neck squamous cell carcinomas (HNSCC). For this reason the SN concept was investigated based on the results of the so far largest group of 100 patients. METHOD: Three groups of patients were investigated. Group 1: In 30 patients (6 x oral cavity, 24 x oropharynx) a dynamic lymphoscintigraphy was performed. Group 2: 60 previously untreated patients (12 x oral cavity, 23 x oropharynx, 16 x larynx, 9 x hypopharynx); neck lymph node status on ultrasound imaging: 39 x N0, 5 x N1, 16 x N2, intraoperative identification of the SN during neck dissection (ND) accomplished according to the extent of assumed lymphogenic metastatic spread; postoperative comparison of the histological result of the SN with the neck dissection specimen. Group 3: 10 previously treated patients (1 x oral cavity, 5 x oropharynx, 1 x larynx, 3 x hypopharynx) in whom an intraoperative SN biopsy was performed. RESULTS: Group 1: In 20/30 patients a cervical lymph drainage could be visualized on dynamic lymphscintigraphy and an activity enrichment above the mean metastatic region could be identified transcutaneously. Group 2: In 34 patients the tumorfree SN1 reflected the regional lymph node status. In 9 patients an isolated tumor metastasis (pN1) was found in the intraoperatively identified SN1 and in a further patient in the SN2 (pN1). CONCLUSION: The results of SN biopsy are encouraging in cases of clinical N0-necks. Nevertheless the data demonstrates that extensive investigations followed by a critical analysis of the results are required. The presented results suggest that the value of the SN concept seems to be of minor importance in cases of advanced lymphogenic metastatic spread.

Adult↗
PubMed1994

Postoperative radiotherapy for cutaneous melanoma of the head and neck region.

PURPOSE: To assess the efficacy and toxicity of elective-adjunctive radiotherapy given in five 6-Gy fractions to patients with cutaneous melanoma of the head and neck at high risk for local-regional relapse. METHODS AND MATERIALS: From 1983 to August 1992, 174 patients (132 men and 42 women) were enrolled. The ages ranged from 16 to 89 years (median: 54 years). One group (n = 79) received elective irradiation after wide local excision of lesions > or = 1.5 mm thick, or Clark's level IV-V, a second group (n = 32) received adjunctive irradiation after excision of primary lesions plus limited neck dissection, and a third group (n = 63) received irradiation after neck dissection for nodal relapse. Each group had a projected local-regional recurrence rate of approximately 50%. The radiotherapy consisted of five fractions of 6 Gy each, specified at Dmax, delivered twice a week, to a total dose of 30 Gy in 2.5 weeks. Electron beams of appropriate energies were used whenever possible. Junction lines between adjoining fields were moved twice to minimize dose heterogeneity. Patients were seen at regular intervals to assess disease status and therapy-related complications. Patients who relapsed were treated as indicated by the clinical status. RESULTS: With a median follow-up of 35 months, 111 of 174 patients were alive. The disease recurred above the clavicles only in six patients, at distant sites in 58 patients, and both local-regionally and at distant sites in nine patients. The actuarial 5-year local-regional control (LRC) and survival rates for the whole group were 88% and 47%, respectively. The thickness of the primary lesion, presence of more than three positive nodes, and extracapsular extension did not influence the LRC rate after radiotherapy (range: 85-92%). However, lesion thickness strongly affected the 5-year survival rate of group 1 patients (i.e., 100% for < or = 1.5 mm thick, but Clark's level IV, 72% for > 1.5-4 mm, and 30% for > 4 mm). In groups 2 and 3, the 5-year survival rate of patients with > three involved nodes was lower than that of patients with one to three positive nodes (23% vs. 39%). The acute tolerance to adjunctive radiotherapy was excellent. Late radiation complications were observed in only three patients. These were moderate neck fibrosis, mild ipsilateral hearing impairment, and transient exposure of external auditory canal cartilage. CONCLUSION: The safety of this hypofractionated radiotherapy regimen in the management of cutaneous melanoma was established in this study. The overall 5-year actuarial LRC rate of 88% was much higher than that of our historical group and that reported in the literature (50%). The survival rate of patients with lesion of 1.5-4 mm thickness was also higher than that observed in other series. Based on these results a prospective randomized study to further define the role of adjunctive postoperative radiotherapy is planned.

Adolescent↗
PubMed1982

Carcinoma of the base of the tongue: results of radical irradiation with surgery reserved for irradiation failure.

Between 1964 and 1977, 95 previously untreated patients with squamous cell carcinoma of the base of the tongue received treatment with curative intent at the University of Florida. Eighty-six of the 95 patients (91%) had Stage III or IV disease at presentation. Eighty-nine patients received radical courses of irradiation to the primary with or without neck dissection(s), with surgery reserved for salvage of irradiation failure. Six patients underwent planned combined treatment of the primary lesion. Of the 89 patients whose primary lesions were radically irradiated, failure at the primary site occurred in 24% of those with T1-3 lesions and 78% with T4 lesions. Control results were related to irradiation treatment technique. None of the 9 patients with Stage I-II disease died of the cancer. Actuarial survival at 5 years for Stage III patients was 46%. Within the Stage IV population there is a subgroup of patients with highly treatable and curable disease. The addition of a neck dissection following irradiation of N2-N3 neck disease decreased the incidence of failure in the neck. No patient developed severe soft tissue necrosis or required mandibulectomy for bone exposure following irradiation.

Carcinoma, Squamous Cell↗
PubMed2003

[Diagnosis and management of squamous cell carcinoma of the head and neck region with unknown primary. A survey of 167 patients].

BACKGROUND: Carcinoma of unknown primary is defined as histological diagnosis of metastasis without diagnosis of a primary tumor. The incidence of CUP is stated in the literature between 3 % and 15 % of all patients with an malignant disease. Histological examination of CUP-metastasis of the neck most frequently shows a squamous cell carcinoma. A retrospective study of patient data was undertaken. PATIENTS AND METHODS: The study included 167 patients admitted and treated for cervical CUP at the department of Oto-Rhino-Laryngology, Klinikum Grosshadern from 1979 to 1998. Cervical swelling was the first noted symptom in all cases. Other symptoms were pain and dysphagia. Of the 167 patients 134 were men and 33 were women. The average age at admission was 55 years. In the studied collective squamous cell carcinoma had the highest incidence (n = 123). During the 10 year follow-up a primary tumor was found in 36 of the 167 initially diagnosed CUP-patients. In over 90 % of these cases the tumor was localized in the head and neck region. The origin of the tumor was most frequently the tonsilla palatina (n = 7). Of the 167 patients included in the study 118 patients (70,7 %) underwent surgery and additional postoperative radiotherapy. Primary radiotherapy was the treatment of choice in 28 patients, 8 patients received combined radio-chemotherapy as primary treatment and 7 patients were treated with chemotherapy alone. No treatment was performed in 6 patients. RESULTS: By comparing the treatment methods there was a significant difference of patient survival in regard to the treatment. Patients treated according to treatment-plan II, which includes an additional "diagnostic" tonsillectomy, is significantly higher than that of patients simply undergoing neck dissection and postoperative radiotherapy or primary radiotherapy alone. Treatment of choice in patients with cervical CUP should be a surgical procedure including radical neck dissection and diagnostic bilateral tonsillectomy followed by postoperative radiation of the cervical lymph drainage. DISCUSSION: Bilateral tonsillectomy is especially important and is correlated with a significant improvement of the survival rate in CUP patients. Additional postoperative radiation of the pharynx from the base of the skull to the upper oesophagus should also be considered, in order to treat a possible--small--primary tumor in this region.

Adult↗
PubMed1976

The place of irradiation in the treatment of malignant tumors of the salivary glands.

1. Radiation therapy is not indicated after surgical removal with adequate margins of low-grade tumor. 2. Radiation therapy is indicated with a) Inadequate surgical margins in low-grade tumors b) All high-grade tumors c) All recurrent malignant tumors 3. Irradiation of nerve pathways is indicated with demonstrated nerve and perineural invasion and/or with adenoicystic carcinoma. 4. Irradiation of the entire ipsilateral neck is indicated a) Wtih high-grade tumors unless radical neck dissection shows negative nodes b) In the place of radical neck dissection.

Adult↗
PubMed1998

Partial vertical laryngectomy in the treatment of early glottic cancer.

Treatment of early glottic cancer is still controversial. A retrospective study was conducted to analyze the results of 49 partial vertical laryngectomies in our department. All patients except 1 were successfully decannulated. The quality of voice was suboptimal but serviceable in all patients. Overall, there were 9 recurrences: 7 in the larynx and 2 in the neck. In the laryngeal recurrence group, 5 of 6 patients were successfully salvaged with total laryngectomy. One patient died of acute renal failure 1 month after salvage operation. Another patient survived 4.5 years after cisplatin-based chemotherapy. In the neck recurrence group, 1 patient was successfully salvaged with neck dissection; the other was lost to follow-up after neck dissection. The actuarial 5-year survival rate was 97.4% and the larynx preservation rate was 88%. The recurrence rate was 14%, when 2 of the 7 laryngeal recurrences were excluded because they occurred beyond 5 years. The results of this series were encouraging. We suggest that partial vertical laryngectomy is a good treatment modality for selected early glottic cancers, especially those of the T1 group.

Adult↗
PubMed1995

The correlation between papillary thyroid carcinoma and lymphocytic infiltration in the thyroid gland.

Ninety-five patients with papillary thyroid carcinoma (PTC) who received primary surgical treatment in 1983 at Kuma Hospital and were followed until 1992 were the subjects of this study. Initial therapy was tumor resection for 5 patients, lobectomy for 23 patients, total thyroidectomy with unilateral modified neck dissection for 60 patients, and total thyroidectomy with bilateral modified neck dissection for 7 patients. Clinical stage at diagnosis was as follows. Class I included 28 patients with intrathyroidal disease, class II included 60 patients with positive cervical lymph nodes, and class II included 7 patients with tumor invasion into tissue outside of the thyroid gland. Recurrence of the tumor was evaluated according to lymphocytic infiltration in the thyroid gland. Group A consisted of 36 patients with PTC associated with lymphocytic infiltration, 26 with infiltration surrounding the tumor, 3 with infiltration inside of the tumor, and 7 with both. Group B consisted of the remaining 59 patients with PTC with no lymphocytic infiltration. There were no differences in age, sex, initial tumor size, or initial treatment between groups A and B. Antithyroglobulin antibody and/or antimicrosomal antibody were positive in 16 patients from group A and 4 patients from group B (P < 0.001). Class I included 14 patients from each group, class II included 22 patients from group A and 38 patients from group B, and class III included 7 patients, all from group B. Recurrence of the tumor was found in only 1 group A patient (2.8%), but in 11 patients of group B (18.6%). The percentage of patients free from recurrence over the 10 yr of follow-up in group A was significantly higher than that in group B (by Cox-Mantel test, P < 0.01). The time between initial treatment and recurrence was 2-10 yr. In comparing the clinical stage at the time of initial treatment, recurrence was found in 1 class II patient from group A (4.5%) and in 1 class I (7.1%), 6 class II (15.8%), and 4 class III (57.1%) patients from group B. No patients died during the 10 yr of follow-up. In conclusion, 1) lymphocytic infiltration surrounding the tumor or inside the tumor in PTC might be of use as a means for predicting a favorable prognosis; and 2) class II or class III patients with no lymphocytic infiltration had a high rate of recurrence.

Adult↗
PubMed1998

[Supraglottic horizontal laryngectomy for supraglottic carcinoma].

OBJECTIVE: To evaluate the therapeutic results of supraglottic horizontal laryngectomy (SHL) for T1 and selected T2, T3 and T4 supraglottic carcinoma. METHODS: One hundred and seven patients undergone SHL during the period of 1979 through 1991 were reviewed retrospectively. All patients were followed up for at least 5 years. RESULTS: The 5 year-survival rate of 6 cases in stage I, 24 cases in stage II, 53 cases in stage III, and 24 cases in stage IV was 100.0%, 83.3%, 71.7% and 41.7%, respectively. Of the 102 patients, 92.2% were decannulated, and 91.6% of all patients achieved satisfactory recovery of phonation. CONCLUSION: SHL is a reliable surgical approach for selected supraglottic carcinoma, even for some advanced lesions, provided the tumor has not extended below the ventricle. The upper neck dissection can be used as an exploratory measure. For N0 neck patients with supraglottic cancer, comprehensive neck dissection is not invariably performed to avoid overtreatment.

Adult↗
PubMed1993

Medullary carcinoma of the thyroid--therapeutic strategy derived from fifteen years of experience.

BACKGROUND: The purpose of this investigation was to analyze our experience with patients treated for medullary carcinoma of the thyroid to identify prognostic factors and to develop a stage-related treatment strategy that might improve cure rates. METHODS: Between 1970 and 1985 a total of 40 patients with medullary thyroid carcinoma were treated (21 women, 19 men; mean age +/- SEM; 40 +/- 3 years; mean follow-up, 82 +/- 12 months). Initial operation involved total thyroidectomy (28 patients), subtotal resection (11 patients), and a lobectomy (1 patient). The initial lymph node dissection generally consisted of a selective removal of enlarged nodes. Unilateral neck dissection was performed in six cases. Secondary operation for recurrent disease was necessary in 26 patients. RESULTS: At the end of the follow-up period 10 patients were tumor free, 12 patients were scheduled for further treatment, six patients suffered from persistent but clinically occult disease, and 12 patients had died (mean survival time, 68 +/- 7 months). The paramount prognostic factor was the absence or presence of lymph node involvement at the time of primary operation (p = 0.011). Patients with distant metastases died within 2 years of diagnosis. Women, patients younger than 40 years of age, and those elicited by familial screening programs exhibited increased survival times. CONCLUSIONS: Because of the prognostic and therapeutic importance we recommend the total thyroidectomy with a complete dissection of the central lymph node compartment as primary treatment. Patients with lymph node involvement or elevated serum calcitonin levels should subsequently be treated by a modified radical neck dissection of the lateral compartments.

Adolescent↗
PubMedDate not supplied

Value of minimal residual disease in patients with early cancer of the tongue.

PURPOSE: The clinical course of patients with squamous cell carcinoma (SCC) of the tongue is often unpredictable. Some patients have a fair course with good response to treatment, whereas others have aggressive locoregional disease despite diagnosis at an early stage. The purpose of the present study was to determine if histochemical staining for cytokeratins of the negative neck nodes obtained in prophylactic neck dissection could predict treatment failure in patients with SCC of the tongue. MATERIALS AND METHODS: Between 1990 and 2000, 18 patients with early squamous cell carcinoma of the tongue (T1,T2N0M0) underwent partial glossectomy with neck dissection at the Rabin Medical Center in Israel. All had clear resection margins and no evidence of neck metastasis and were expected to do well. Nevertheless, 6 patients had an aggressive course and died of disease shortly after presentation because of local or regional failure. In an attempt to predict failure of treatment and patients' outcome, paraffin-embedded blocks from the pathologically negative lymph nodes were subjected to immunohistochemical staining for cytokeratin using polyclonal antibodies. The antigen-antibody complex was identified by using the biotinylated secondary antibody and followed by the streptavidin-peroxidase detection method. RESULTS: None of the 142 sections from pathologically negative lymph nodes stained positive for keratin. On multivariate analysis, a statistically significant relationship was found between disease-free survival, early recurrence (P =.03), and metastasis to the neck (P =.008). CONCLUSIONS: Keratin staining failed to yield evidence of micrometastasis. Further studies with more samples are needed to confirm these findings.

Adult↗
PubMed1994

Superficial parotidectomy in the treatment of cutaneous melanoma of the head and neck.

The preauricular lymph nodes are frequently the first site of metastatic disease from primary malignant melanoma of the upper two-thirds of the face or the anterior scalp. For these patients, or those with adjacent metastatic nodal disease, the prognosis is poor. The median survival of 13 such patients presented was 2 years, with two long-term survivors at 4 and 6 years. Palliative surgery can, however, prevent uncontrolled locoregional disease. Patients with palpable preauricular and cervical node disease should be treated by facial nerve-preserving parotidectomy and radical neck dissection. When no cervical nodes are palpable in patients with preauricular node metastasis, peroperative jugulodigastric node biopsy and frozen-section histopathological examination are useful to select patients for radical neck dissection.

Adolescent↗