Predicting the pattern of regional metastases from cutaneous squamous cell carcinoma of the head and neck based on location of the primary

Background. We aimed to analyze the distribu- tion of regional nodal metastases according to primary tumor location in patients with cutaneous squamous cell carcinoma of the head and neck (SCCHN). Methods. Analysis of 295 neck dissections performed for patients with clinically evident regional metastases from cuta- neous SCCHN between 1987 and 2009. Results. Level I involvement in the absence of level II or III only occurred in patients with facial primaries. In patients with clear nodes in level II-III, the risk of level IV-V involvement was 0.0% for external ear primaries, 2.7% for face and anterior scalp, and 15.8% for posterior scalp and neck. Conclusion. In patients undergoing parotidectomy for met- astatic cutaneous SCCHN with a clinically negative neck, the results of this study support selective neck dissection including level I-III for facial primaries, level II-III for anterior scalp and external ear primaries, and levels II-V for posterior scalp and neck primaries. V C 2010 Wiley Periodicals, Inc. Head Neck 32: 1288-1294, 2010