Prognostic factors for lymph node metastasis from advanced squamous cell carcinoma of the skin of the trunk and extremit

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Prognostic factors for lymph node metastasis from advanced squamous cell carcinoma of the skin of the trunk and extremities Vinicius de Lima Vazquez*1, Teoclito Sachetto2, Natalia Martins Perpetuo1 and Andre Lopes Carvalho1 Address: 1Department of Surgery, Hospital de Cancer de Barretos, Rua Antenor Duarte Villela, 1331 Barretos – SP, 14784-400, Brazil and 2Department of pathology, Hospital de Cancer de Barretos, Rua Antenor Duarte Villela, 1331 Barretos – SP, 14784-400, Brazil Email: Vinicius de Lima Vazquez* - [email protected]; Teoclito Sachetto - [email protected]; Natalia Martins Perpetuo - [email protected]; Andre Lopes Carvalho - [email protected] * Corresponding author

Published: 4 July 2008 World Journal of Surgical Oncology 2008, 6:73

doi:10.1186/1477-7819-6-73

Received: 3 March 2008 Accepted: 4 July 2008

This article is available from: http://www.wjso.com/content/6/1/73 © 2008 Vazquez et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract Background: Squamous cell carcinoma (SCC) of the skin of the trunk and extremities may present lymph node metastasis with difficult disease control and poor survival. The purpose of this study was to identify risk factors for lymph node metastasis and outcome. Patients/Methods: Retrospective review of 57 patients with locally advanced SCC of the trunk and extremities was performed and several clinical variables including age, gender, ethnicity, previously injured skin (burns, scars, ulcers and others), patient origin (rural or urban), anatomic site and treatment were studied. Results: Fifteen patients presented with previous skin lesions. Thirty-six were classified as T3 tumors and 21 as T4; 46 were N0, and 11, N1. Eleven N0 patients presented lymph node metastasis during follow up. Univariate analysis identified previous skin lesions (ulcers and scars) as risk factor for lymph node metastasis (p = 0.047). Better survival was demonstrated for T3 (p = 0.018) classification. N0 patients who presented lymph node metastasis during follow up (submitted to lymphadenectomy) had similar survival to patients without lymph node recurrence (p = 0.219). Conclusion: Local advanced tumors are at risk of lymph node metastasis. Increased risk is associated to previous lesions at tumor site. T4 classification have worse prognosis. Lymph node recurrences in N0 patients, once treated, did not affect survival. For these patients, we propose close follow up and prompt treatment of lymph node metastasis. These results do not support indication for elective lymphadenectomy or sentinel node mapping. Further prospective studies must address this issue.

Background Squamous cell carcinoma of the skin (SCCS) is one of the most common cancers around the word [1,2], with an increasing incidence at a rapid rate