Completion Lymph Node Dissection Based on Risk of Nonsentinel Metastasis in Cutaneous Melanoma of the Head and Neck.

OBJECTIVE: Theoretically, completion lymph node dissection (CNLD) should have the lowest benefit in the absence of nonsentinel lymph node (NSLN) metastases. For this reason, substantial research efforts have attempted to define specific criteria that are associated with a low-enough risk of NSLN positivity so that CLND can be deferred. Our objectives were (1) to identify features associated with low risk of NSLN positivity in sentinel lymph node-positive cutaneous melanoma of the head and neck (CMHN) and (2) to analyze the effect of CLND on 5-year disease-specific survival (DSS) among subgroups stratified by risk of NSLN metastasis. STUDY DESIGN: Retrospective analysis of population-based data. SETTING: SEER database. SUBJECTS AND METHODS: Patients with sentinel lymph node-positive CMHN were categorized according to lymph node treatment following sentinel lymph node biopsy (SLNB): 210 underwent CLND and 140 deferred. Clinicopathologic characteristics and survival were compared between SLNB+CLND and SLNB-only groups. Survival analyses were stratified by age and characteristics associated with NSLN positivity. RESULTS: Minimal tumor thickness and nonulceration were associated with lowest risk of positive NSLN (P < .025). In the subgroup with the lowest risk of metastasis, patients aged <60 years who underwent CLND+SLNB had markedly better DSS than those receiving SLNB only (>90% vs <25%; P < .0025). Paradoxically, in subgroups with a higher risk of NSLN metastasis, DSS was similar whether CLND was performed or not (P > .25). CONCLUSIONS: Selecting patients for CLND according to risk of NSLN metastasis may be a suboptimal strategy for improving DSS. We believe that CLND should not be withheld on the basis of "low risk" features in CMHN.

Spindle cell carcinoma of the upper aerodigestive tract: an analysis of 341 cases with comparison to conventional squamous cell carcinoma.

OBJECTIVES: We sought to better characterize spindle cell carcinoma (SpCC) of the upper aerodigestive tract, a rare and aggressive variant, through comparison of a large cohort of head and neck SpCCs against a cohort of conventional head and neck squamous cell carcinoma (SCC) patients. METHODS: We compared epidemiologic and clinicopathologic characteristics of 341 SpCCs with 67 882 SCCs of the head and neck, drawing data from the SEER national database. We also compared disease-specific survivals (DSS) for SpCC and SCC based on tumor site and mode of treatment. RESULTS: SpCCs were predominantly laryngeal (46.4%, P < .001) and were more likely to be high grade (P > .001). SpCCs were also more likely than SCCs to present at an early stage (P < .001 to P < .05). Rates of distant metastasis were similar between the tumor types. DSS was similar between SpCCs and SCCs, although site-specific survival rates were higher for SpCCs of the larynx (P = .017) and lower for those of the oral cavity (P = .008). CONCLUSION: SpCC of the head and neck is more likely than SCC to present at an early stage, with fewer nodal metastases. Survival rates appear to depend on anatomic site as well.

Comparison of survival rates between papillary and follicular thyroid carcinomas among 36,725 patients.

OBJECTIVES: We sought to determine the impact of histologic subtype on disease-specific survival (DSS) in cases of differentiated thyroid carcinoma. METHODS: Adult patients with papillary thyroid carcinoma (PTC) or follicular thyroid carcinoma (FTC) were identified from the Surveillance, Epidemiology, and End Results (SEER) Database for the years 1988 to 2003. The patients were grouped according to tumor type (PTC or FTC), and their age, gender, tumor size and extension, and nodal or distant metastases were recorded. The Kaplan-Meier method was used to compare DSS rates on the basis of histologic subtype. RESULTS: We identified 36,725 patients, of whom 77% were female and 23% were male; PTC was diagnosed in 91% of patients, and FTC in the remaining 9%. Patients with PTC were younger, were more likely to be female, and had smaller tumors with higher rates of regional metastases but fewer distant metastases than FTC patients (p < 0.0001 for all). When the cases were stratified by stage, FTC patients had a worse DSS than did PTC patients for all stages - except for stages III/IVA and IVC among patients more than 45 years of age. CONCLUSIONS: Follicular thyroid carcinoma portends a worse DSS than does PTC, even when the cases are controlled for stage. Consideration should be given to individual staging for these subtypes of differentiated thyroid carcinoma.

Basaloid squamous cell carcinoma of the head and neck: location means everything.

BACKGROUND AND OBJECTIVES: Head and neck basaloid squamous cell carcinoma (BSCC) is increasingly recognized as a malignancy with an evolving duel behavior. Our objective was to describe the site-specific presentation and prognosis of head and neck BSCC in comparison to conventional-type squamous cell carcinoma (SCC) using population-based data. METHODS: A total of 1,083 BSCC patients and 66,929 conventional-type SCC patients, diagnosed between 2000 and 2008, were identified using the Surveillance, Epidemiology, and End Results database. Clinicopathologic data were compared using χ(2) analysis. Kaplan-Meier analysis was used to estimate site-stratified disease-specific survival (DSS). BSCC's independent effect on DSS was assessed by multivariable regression analysis. RESULTS: The oropharynx (61.9%) was the most frequent BSCC site; compared to the larynx (33.3%) in conventional-type SCC. More BSCC patients presented with advanced-stage disease (78.4% vs. 60.1%, P < 0.001). On multivariable analysis, DSS was significantly better in the BSCC group when tumors were located in the oropharynx. Conversely, DSS was worse for BSCC patients with laryngeal tumors. DSS was similar among patients with sinonasal, nasopharyngeal, hypopharyngeal, and oral tumors. CONCLUSIONS: BSCC's propensity for advanced-stage presentation was confirmed in this study. However, BSCC appears to carry a paradoxically similar, or better, prognosis compared to conventional-type SCC in most cases.

Sentinel lymph node status in Merkel cell carcinoma of the head and neck: not a predictor of survival.

BACKGROUND: The effect of sentinel lymph node status on survival in patients with Merkel cell carcinoma (MCC) of the head and neck is uncertain. METHODS: We used the Surveillance Epidemiology and End Results (SEER) database to identify patients with MCC who underwent sentinel lymph node biopsy (SLNB). Clinicopathologic data and disease-specific survival (DSS) were compared among patients with positive and negative sentinel lymph nodes. RESULTS: We identified 721 patients with cutaneous MCC who underwent SLNB, of which 173 (24%) had head and neck MCC. The rate of sentinel lymph node positivity in patients with head and neck MCC was 23.1%. Sentinel lymph node metastasis did not significantly affect survival in head and neck MCC (p = .139). CONCLUSION: Using the SEER database, we report what we believe to be the largest head and neck MCC study to date. Our results suggest that sentinel lymph node status does not predict survival in head and neck MCC. Independent predictors of MCC-related mortality seem to be unique in the head and neck region.

Basaloid squamous cell carcinoma of the oral cavity: an analysis of 92 cases.

OBJECTIVES/HYPOTHESIS: Basaloid squamous cell carcinoma (BSCC) is considered a rare and possibly more aggressive squamous cell carcinoma (SCC) variant. Until now, a series of exclusively oral cavity BSCC patients has not been previously reported. We endeavored to compare BSCC and SCC of the oral cavity, focusing on epidemiologic factors and survival outcomes. STUDY DESIGN: Retrospective analysis of population-based data. METHODS: We compared epidemiologic factors, clinicopathologic data, and disease-specific survivals (DSS) between 92 patients with oral cavity BSCC and 15,181 patients with SCC. RESULTS: High-grade tumors and distant metastases were more common in the BSCC group (P≤0.001). On multivariable analysis controlling for disease stage, BSCC patients had similar DSS to those with typical SCC (P=0.231). Although there was a trend favoring definitive radiotherapy for BSCC, there were no significant differences in treatment approach between BSCC and SCC. The choice of treatment modality (radiation, surgery±radiation) did not reveal a difference in DSS between the two tumor subtypes. CONCLUSION: Analysis of the largest oral cavity BSCC series to date demonstrates that BSCC of the oral cavity carries a comparable prognosis to conventional-type oral SCC. LEVEL OF EVIDENCE: 2b.

Basaloid squamous cell carcinoma of the larynx: analysis of 145 cases with comparison to conventional squamous cell carcinoma.

BACKGROUND: Basaloid squamous cell carcinoma (BSCC) is a rare subtype squamous cell carcinoma (SCC) that frequently occurs in the larynx. BSCC is generally considered an aggressive SCC variant; however, because of its rarity, most studies are underpowered to detect statistical differences in disease-specific survival (DSS). METHODS: Using the Surveillance, Epidemiology, and End Results (SEER) database, we compared clinicopathologic data and DSS between patients with laryngeal BSCC and SCC. RESULTS: Patients with relative SCC, those with laryngeal BSCC, presented with more advanced local, regional, and distant disease (p < .001). Patients with BSCC had worse DSS, regardless of stage, tumor location within the larynx (glottis/supraglottis; p < .001), or treatment received (p ≤ .052). CONCLUSION: Analysis of the largest laryngeal BSCC series to date (n = 145) demonstrates that BSCC carries a worse prognosis than conventional SCC of the larynx.

Population-based analysis of prognostic indicators in sebaceous carcinoma of the head and neck.

OBJECTIVES/HYPOTHESIS: Due to the rarity of sebaceous carcinoma of the head and neck, few large series have been reported and prognostic factors remain largely undetermined. This study presents prognostic factors in survival in sebaceous carcinoma of the head and neck. STUDY DESIGN: Retrospective analysis was performed using the Surveillance Epidemiology and End Results (SEER) database for patients diagnosed with sebaceous carcinoma of the head and neck (SCHN). METHODS: Clinicopathologic, treatment data, and 5-year disease specific survival were analyzed using univariable and multivariable regression analysis and Kaplan-Meier methodology. RESULTS: Of the 1,433 patients identified to have SCHN, 16 were node-positive (1.14%). On multivariable analysis, independent prognostic indicators were: age at diagnosis (HR = 1.03, P = .021), tumor grade (HR = 4.97, P = .038), and distant metastasis (HR = 7.52, P = .006). Nodal metastasis occurred exclusively with poorly or undifferentiated tumors and was not a significant prognostic factor on multivariable analysis. CONCLUSION: Elderly patients and patients with poorly differentiated tumors and/or distant disease at presentation have the highest risk of disease-specific mortality. Lymph node metastasis does not appear to be an independent prognostic factor in sebaceous cell carcinoma.

Squamous cell carcinoma of the uvula: an analysis of factors affecting survival.

OBJECTIVES/HYPOTHESIS: Uvular squamous cell carcinoma (SCC) is usually considered with soft palate tumors as an oropharyngeal cancer subsite. This investigation aims to determine whether the uvula itself is a high-risk subsite in the oropharynx for primary squamous cell carcinomas. STUDY DESIGN: Retrospective analysis of a large population database. METHODS: Using the Surveillance, Epidemiology, and End Results database, we identified patients with T1 and T2 SCC of the oropharynx. Patients were categorized into two groups based on primary site: 1) uvula; and 2) oropharynx not otherwise specified. Clinicopathologic characteristics and disease-specific survival (DSS) were compared between the two groups. RESULTS: Of the 9,833 patients we identified, 129 (1.3%) had primary uvular tumors. Primary tumors of the uvula were more likely to be smaller lesions at diagnosis (P < .001) and to present at a lower anatomical stage (P < .001). They also presented with less concurrent nodal metastasis (P < .001) and lower histological grade (P < .001). There was no evidence that size of uvular SCC lesion had any effect on nodal disease (P = .54), and survival was the same for T1 and T2 uvular SCC patients (P = .14). DSS was similar between the two groups as well (P = .7629). CONCLUSIONS: Our data indicate that primary SCC of the uvula does not have a worse prognosis, and tends to be recognized earlier and treated more definitively than SCC found in other oropharyngeal regions. However, survival being equivalent between two distinctive groups is perplexing, and may indicate an underlying aggressiveness to uvular cancers.

Basaloid squamous cell carcinoma of the oropharynx: an analysis of 650 cases.

OBJECTIVE: Basaloid squamous cell carcinoma (BSCC) is considered an aggressive squamous cell carcinoma (SCC) variant. However, we hypothesized that BSCC of the oropharynx may carry a similar prognosis to SCC. A series of exclusively oropharyngeal BSCC patients has not been previously reported. Our objective was to describe the clinical presentation and prognosis of BSCC in a large series of patients with BSCC of the oropharynx and to compare these with a series of patients with conventional-type oropharyngeal SCC. STUDY DESIGN: Retrospective analysis of population-based data. SETTING: Data reported by the Surveillance, Epidemiology, and End Results (SEER) program are based on medical records of patients who are treated at academic medical centers, community and county hospitals, and health maintenance organizations. SUBJECTS AND METHODS: Clinicopathologic data and disease-specific survival (DSS) were compared between 650 patients with oropharyngeal BSCC and 19,484 with SCC. RESULTS: High-grade tumors and nodal metastasis were more common in the BSCC group (P < .02). On multivariable analysis controlling for disease stage, BSCC patients had improved DSS (P < .001). More BSCC patients received multimodality treatment (P < .001). Disease-specific survival was similar in BSCC and SCC patients who were treated with primary surgery; however, among patients who received radiotherapy, DSS was better for those with BSCC (P < .04). CONCLUSION: Analysis of the largest oropharyngeal BSCC series to date demonstrates that BSCC of the oropharynx carries a more favorable prognosis than conventional-type oropharyngeal SCC.