Sentinel Node Lymphoscintigraphy in High-risk Cutaneous Squamous Cell Carcinoma

Abstract

BackgroundHigh-risk cutaneous squamous cell carcinoma includes recurrent disease, a tumor diameter > 2 cm, T4 stage, perineural or lymphovascular invasion, tumor depth of ≥ 4 mm, and high-grade histologic features. All have been implicated in an increased risk of occult regional lymph node involvement. Patients and MethodsAmong a large group of patients with nonmucosal, cutaneous squamous cell carcinoma seen at our center, 30 patients with high-risk inclusion criteria were prospectively evaluated to undergo wide local excision and sentinel lymph node mapping. ResultsWith a median follow-up period of 56 months, 4 patients (13%) had regional lymph nodal involvement. The patients identified with lymph node-positive disease underwent adjuvant therapy. Five patients (17%), none of whom had nodal disease at diagnosis, developed locally recurrent disease requiring additional therapy. On multivariate analysis, a statistically significant correlation was found between the depth of tumor invasion and occult sentinel lymph node involvement. ConclusionIn the present prospective analysis, sentinel lymph node mapping resulted in upstaging in 13% of the patients. The tumor depth was independently associated with an increased risk of nodal involvement. Given the association between a depth of tumor invasion of ≥ 4 mm and occult nodal disease in cutaneous squamous cell carcinoma, sentinel lymph node mapping could be considered an integral part of surgical staging for patients with high-risk features.