Acta Dermato-Venereologica 99-13CompleteContent | Page 13

CLINICAL REPORT 1241 Cutaneous Squamous Cell Carcinoma Tumour Size is Associated with Sentinel Lymph Node Metastasis in a Cohort of 69 Patients Emilien CHABRILLAC 1,2 , Amélie LUSQUE 3 , Zoé CAVALLIER 4 , Raphaël LOPEZ 4 , Thomas FILLERON 3 , Jérôme SARINI 2 , Nicolas MEYER 5# and Sébastien VERGEZ 1,2# Department of ENT-Head and Neck Surgery and 5 Department of Dermatology, University Cancer Institute Toulouse and Toulouse University Hospital, Hôpital Larrey, 2 Department of Surgery and 3 Department of Biostatistics, Institut Claudius Regaud, University Cancer Institute Toulouse – Oncopole, 4 Department of Maxillofacial and Facial Plastic Surgery, University Cancer Institute Toulouse and Toulouse University Hospital, Hôpital Pierre-Paul Riquet, Toulouse, France # These authors contributed equally to this manuscript. 1 Ten to fifty percent of high-risk cutaneous squamous cell carcinoma may potentially metastasize. However, the concept of sentinel lymph node biopsy remains controversial for cutaneous squamous cell carcinoma. The aim of this study was to identify prognostic factors associated with sentinel lymph node positivity. A bi­ centric retrospective analysis was conducted between January 2006 and January 2018. All patients undergo­ ing sentinel lymph node biopsy for high-risk cutaneous squamous cell carcinoma were included, based on the criteria of the prognostic classification of the French Society of Dermatology. Seventy-four patients were included. Five (6.8%) procedures failed. Of the 69 pa­ tients assessed, the positive sentinel lymph node biop­ sy rate was 11.6% (n  = 8) with a false negative rate of 5.7% (n  = 4). The positivity of sentinel lymph node biopsy was associated with tumour size (p  = 0.0194). Sentinel lymph node biopsy is an effective staging pro­ cedure for clinically N0 high-risk cutaneous squamous cell carcinoma, with an acceptable morbidity. To date, 2 risk factors of sentinel lymph node positivity have been identified with statistical significance: tumour size and poor tumour differentiation. Key words: high-risk cutaneous squamous cell carcinoma; sen- tinel lymph node biopsy; risk factor; tumour size. Accepted Aug 12, 2019; E-published Aug 13, 2019 Acta Derm Venereol 2019; 99: 1241–1245. Corr: Emilien Chabrillac, Department of ENT-Head and Neck Surgery, University Cancer Institute Toulouse and Toulouse University Hospital, Hôpital Larrey 24 Chemin de Pouvourville, FR-31400 Toulouse, France. E-mail: [email protected] C utaneous squamous cell carcinoma (cSCC) is the second most common cancer in humans. Its inci- dence varies worldwide and is estimated at approxima- tely 25/100,000 inhabitants in France (1). Indeed, the highest incidence is 499/100,000 for Australian men and 291/100,000 for Australian women (2). Seventy-five per- cent of cases develop on sun-exposed areas of the head and neck (3, 4). The lifetime risk ranges from 4% to 14% (3), and is currently increasing as the population ages (5). Most cSCCs have a favourable prognosis and can be cured by a surgical excision when treated at an early stage. However, when a cSCC has some high-risk features, its po- SIGNIFICANCE Among patients presenting a cutaneous squamous cell car- cinoma, this study analyses the patient’s and tumour’s cha- racteristics associated with metastasis in the first draining lymph node, called the “sentinel lymph node”. The results show that a large tumour size is a risk factor for lymph node metastasis. tential to metastasize increases up to 10–50% (6, 7). Small metastases can be clinically and radiologically occult. cSCC mortality usually results from uncontrolled regional metastasis (8, 9), which should therefore be tracked. Distant metastases are rare and generally occur at a later stage of the disease, after regional nodal involvement. Sentinel lymph node biopsy (SLNB) allows the iden- tification and pathological analysis of the first tumour- draining lymph nodes. This concept was initially used in breast cancers and, more recently, in cutaneous melanoma and oral cavity squamous cell carcinomas. The value of the SLNB is well-established in these indications: this staging procedure ensures better sensitivity and specificity than the imaging work-up (10–12), lower morbidity than the prophylactic lymph node dissection (13, 14) and seems cost-effective (15). However, SLNB is still not routinely recommended in the work-up of clinically N0 high-risk cSCC because of a lack of high-level evidence, not in terms of efficiency (16, 17) but in terms of patient screening. Although more data are being published on this topic, to our knowledge, the largest series reported included 83 patients with high- risk cSCC (18) and the procedure remains controversial. This paper discusses the experience of 2 Toulouse-based teams in SLNB for cSCC. The aim of this study was to identify prognostic factors associated with SLN positivity. METHODS This bicentric retrospective analysis was conducted between January 2006 and January 2018. We included all patients who underwent SLNB for a cN0 high-risk cSCC in the ENT, maxillo- facial or plastic surgery department of 2 French tertiary referral centres in Toulouse. As there is no clear-cut recommendation, the regional dermatology multidisciplinary tumour board indicated SLNB in both centres on a case-by-case basis, for cN0 cSCCs This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3293 Acta Derm Venereol 2019; 99: 1241–1245