Sentinel lymph node biopsy for high-risk cutaneous squamous cell carcinoma: clinical experience and review of literature
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WORLD JOURNAL OF SURGICAL ONCOLOGY
REVIEW
Open Access
Sentinel lymph node biopsy for high-risk cutaneous squamous cell carcinoma: clinical experience and review of literature Steve Kwon1, Zhao Ming Dong2 and Peter C Wu1,3*
Abstract High-risk cutaneous squamous cell carcinoma (SCC) is associated with an increased risk of metastases. The role of sentinel lymph node (SLN) biopsy in these patients remains unclear. To address this uncertainty, we collected clinical data on six patients with clinical N0 high-risk SCC that underwent SLN biopsy between 1999 and 2006 and performed a literature review of SLN procedures for SCC to study the utility of SLN biopsy. There were no positive SLN identified among six cases and there was one local and one distant recurrence on follow-up. Literature review identified 130 reported cases of SLN biopsy for SCC. The SLN positivity rate was 14.1%, 10.1%, and 18.6%; false negative rate was 15.4%, 0%, and 22.2%; and the negative predictive value was 97.8%, 100%, and 95.2% for all sites, head/neck, and truncal/extremity sites, respectively. SLN biopsy remains an investigational staging tool in clinically node-negative high-risk SCC patients. The higher false negative rate and lower negative predictive value among SCC of the trunk/extremity compared to SCC of the head/neck sites suggests a more cautious approach when treating patients with the former. Given the paucity of long-term follow up, an emphasis is placed upon the need for close surveillance regardless of SLN status. Keywords: sentinel lymph node, squamous cell carcinoma, cutaneous, staging
Introduction Cutaneous squamous cell carcinoma (SCC) is overall the second most common skin cancer with approximately 200,000 new cases diagnosed each year in the U.S. and accounts for nearly 25% of annual skin cancer deaths [1-4]. Fortunately, the majority of cases is associated with a favorable prognosis and is often curable by surgical or local destructive therapy. However, a small subset of SCC tumors can be characterized by aggressive biologic behavior with an increased risk of locoregional recurrence and distant metastases. Numerous studies have identified high-risk factors in SCC patients [5-7] associated with a worse prognosis including large size, rapid growth rate, irregular borders, moderate/poor differentiation, perineural invasion, recurrent lesions, sites of prior radiotherapy or chronic inflammation, immunocompromised states, and genetic disorders including albinism and xeroderma pigmentosum. In terms of size * Correspondence: [email protected] 1 Department of Surgery, University of Washington, Seattle, WA, USA Full list of author information is available at the end of the article
and location, SCC tumors are considered high-risk when measuring greater than 2 cm on the trunk and extremities; > 1 cm on the cheeks, forehead, scalp and neck; and > 0.6 cm on the “mask areas” of the face, genitals, hands and feet. More recent studies have suggested that tumor thickness (Clark’s level IV), desmoplastic growth, and development of nodal meta
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