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Radiation Oncology • Melanoma/Skin Cancer
How do you decide whether or not to cover elective lymphatics when treating cutaneous squamous cell carcinoma of the head and neck with definitive RT?
Unlike in post-operative cases, you lack detailed pathologic information in this scenario. Do you base your decision on location, size, and/or pathologic features on biopsy? Do you use any published tools to predict risk of lymph node involvement?
Answer from: Radiation Oncologist at Academic Institution
I dont think there's a good, single, validated tool for determining when nodes should be selectively treated in cutaneous SCC. Various sources suggest risk factors for nodal disease - size > 2 cm, depth > 4mm, poorly differentiated tumors, PNI, LVSI, immunosuppression, recurrent disease,...
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Answer from: Radiation Oncologist at Academic Institution
Cutaneous squamous cell carcinoma of the scalp spreads to the head and neck lymphatics more frequently than most physicians realize. The decision as to whether or not to prophylactically treat the lymphatics depends upon the location of the tumor, the size of the lesion, and its degree of diff...