Monthly Archives: June 2006

GDPs’ perceptions of the WoSCAP oral cancer campaign

  • 6/30/2006
  • Scotland, Great Britain
  • GR Ogden
  • Br Dent J, June 24, 2006; 200(12): 675

The 2003/04 West of Scotland Cancer Awareness Programme oral cancer campaign was designed to raise public awareness of the signs and symptoms of oral cancer. The objectives of this study were to explore general dental practitioners’ (GDPs) awareness and perceptions of the campaign, and its impact on local dental practices.

A self-completing questionnaire was sent to GDPs in the West of Scotland (N = 983) at the conclusion of the public awareness campaign.

A response rate of 68.6% was achieved. Most dentists (92%) had heard of the campaign and a large percentage had displayed the promotional materials in their practice. The majority of respondents rated the campaign materials, including a television advertisement, in a very positive manner. Over 40% of dentists reported that, during the active phase of the campaign, patients had asked for information concerning the programme, and 66% indicated that registered patients had asked for advice regarding a specific lesion. Additionally, 41% of dentists reported non-registered patients had attended asking for advice regarding a ‘worrying’ lesion. Over 60% of dentists had referred a patient during the campaign and 40% of these practitioners indicated an increased referral rate during this period.

Most respondents were positive in their assessment of the campaign and reported an increased awareness of oral cancer among patients.

June, 2006|Archive|

Rate of pathologic complete responses to docetaxel, Cisplatin, and Fluorouracil induction chemotherapy in patients with squamous cell carcinoma of the head and neck

  • 6/30/2006
  • Boston, MA
  • R Haddad et al.
  • Arch Otolaryngol Head Neck Surg, June 1, 2006; 132(6): 678-81

To report the rate of pathological complete response after induction chemotherapy with the docetaxel, cisplatin, and fluorouracil (TPF) combination.

Retrospective cohort analysis. SETTING: Tertiary care academic cancer center, between June 1999 and May 2004.

Seventy-two patients with newly diagnosed squamous cell carcinoma of the head and neck; 68 (95%) of the patients had stage IV, locally advanced disease.

Three cycles of induction chemotherapy followed by a biopsy of the primary site. All patients subsequently underwent chemotherapy with 3 cycles of TPF.

Main Outcome Measure:
Rate of pathological complete response at the primary site after induction chemotherapy with 3 cycles of TPF.

Biopsy results were negative for cancer in 64 patients (89%) and positive in 8 patients (11%). The median follow-up was 2 years. In the positive biopsy result group, 2 (25%) of 8 patients died of disease vs 3 (4%) of 64 patients in the negative biopsy result group. Twenty-nine neck dissections were performed; results were positive in 7 patients (all alive with no evidence of disease) and negative in 22 patients (21 alive with no evidence of disease). The overall 2- and 5-year progression-free survival is currently projected at 85% and 85%, respectively; the overall 2- and 5-year survival, at 95% and 90%, respectively. Importantly, T4 presentation did not predict a positive biopsy result at the primary site or a positive neck dissection result (P = .60 and P = .56, respectively). N3 presentation (12 patients) did not predict a positive biopsy result at the primary site (P = .87) but did correlate with positive neck dissection results in 6 of 12 patients (P<.001).

Induction chemotherapy with the TPF regimen results in a high pathological complete response rate (89%). This rate is higher than with the cisplatin plus fluorouracil combination therapy, which was reported to be between 25% and 50% in previous studies. Chemoradiotherapy is currently an accepted standard of care, but induction chemotherapy continues to be investigated. Based on recent phase 3 trial results and the data presented herein, we propose that the 3-drug combination be used as the new platform when administering induction chemotherapy.

R Haddad, R Tishler, L Wirth, CM Norris, L Goguen, C Sullivan, L O’Donnell, Y Li, and M Posner

Authors’ affiliation:
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass, USA

June, 2006|Archive|

OHSU Cancer Institute researchers get closer to predict survivability for some cancer patients

  • 6/27/2007
  • Portland, OR
  • staff

Oregon Health & Science University Cancer Institute researchers have developed a Web-based software program that can help head and neck cancer patients better predict their survivability.

“This new tool can help us make personalized predictions of conditional survival for an individual patient depending on his or her specific situation,” said Sam Wang, M.D., Ph.D., principal investigator, Holman Pathway Resident in the Department of Radiation Medicine, OHSU School of Medicine.

Conditional survival is a statistical system that takes into account the age when the patient was diagnosed with cancer and the time elapsed since diagnosis. The new Web-browser software tool, called the regression model, can calculate a patient’s conditional survival based on the patient’s age, gender, race and tumor site, stage and aggressiveness.

The study was recently presented at the annual American Society of Clinical Oncologists.

In a previous study researchers, including Wang, demonstrated the concept of conditional survival for head and neck cancer. They showed the longer patients survive after diagnosis and treatment, their better their prognosis.

“This is the first time we have the ability to make a customized prediction of conditional survival probability for an individual head and neck cancer survivor, based on his or her specific characteristics,” said Wang.

The long-term goal is to build similar software tools for other cancers, Wang explained,so that physicians will be able to give cancer patients more individualized prognosis and treatment recommendations.

“Now that cancer researchers are beginning to collect more specific information about patients’ tumors, such as tumor markers and genetic information, there is increasing interest in the development of these types of tools for making more specific predictions of a patient’s prognosis,” Wang said.

Other researchers contributing to this study include: Clifton David Fuller, M.D., resident in the Department of Radiation Oncology and a trainee in Human Imaging/Radiobiology, Division of Radiological Sciences, University of Texas Health Science Center at San Antonio; Dean Sittig, Ph.D., director, Applied Research in Medical Informatics Northwest Permanente; John Holland, M.D., associate professor of radiation medicine, OHSU School of Medicine, a member of the OHSU Cancer Institute; and Charles Thomas Jr., M.D., chairman, Department of Radiation Medicine, OHSU School of Medicine and a member of the OHSU Cancer Institute.

Wang is also a post-doctoral fellow in the Department Medical Informatics and Clinical Epidemiology, OHSU School of Medicine. The research was funded by a National Institutes of Health’s National Library of Medicine post-doctoral fellowship in biomedical informatics.

The OHSU Cancer Institute is the only National Cancer Institute-designated center between Sacramento and Seattle. It comprises some 120 clinical researchers, basic scientists and population scientists who work together to translate scientific discoveries into longer and better lives for Oregon’s cancer patients. In the lab, basic scientists examine cancer cells and normal cells to uncover molecular abnormalities that cause the disease. This basic science informs more than 200 clinical trials conducted at the OHSU Cancer Institute.

June, 2006|Archive|

Quality of Life After Neck Dissection

  • 6/24/2006
  • Chicago, IL
  • Hiroyuki Inoue, MD et al.
  • Arch Otolaryngol Head Neck Surg. 2006;132:662-666

To assess the impact of modifications to radical neck dissection on postoperative quality of life.

Cross-sectional study using a self-administered neck dissection questionnaire and an arm abduction test.

Department of Otolaryngology–Head and Neck Surgery, Kobe University Hospital.

Seventy-four patients who had undergone neck dissection for the treatment of head and neck cancer.

Main Outcome Measures:
Arm abduction test results and responses to questions on quality of life related to neck dissection.

Forty-one patients underwent bilateral neck dissections, and 33 patients underwent unilateral neck dissection. Level V nodes were dissected in 74 necks. Among them, the spinal accessory nerve (SAN) was resected in 29 necks. Patients who had neck dissections that spared the SAN had better shoulder function. When the SAN was preserved, patients without dissection of level IV and V nodes had better scores on measures of pain and constriction of the neck. Sacrifice of the sternocleidomastoid muscle and/or the SAN had a significant effect on daily activities, work, and leisure. The arm abduction test scores and answers to questions regarding shoulder function were significantly correlated.

Modifications to radical neck dissection contribute to improvements in the postoperative quality of life after neck dissection. A multicenter study using the arm abduction test and questionnaire used in this study is currently in progress to further evaluate the impact of modifications to radical neck dissection on quality of life after surgery.

Hiroyuki Inoue, MD; Ken-ichi Nibu, MD, PhD; Miki Saito, MD; Naoki Otsuki, MD; Haruhiko Ishida, MD; Tetsuro Onitsuka, MD; Takashi Fujii, MD; Kazuyoshi Kawabata, MD; Masahisa Saikawa, MD

Authors’ affiliations:
Department of Otolaryngology–Head and Neck Surgery, Kobe University Hospital, Kobe, Japan (Drs Inoue, Nibu, Saito, Otsuki, and Ishida); Division of Head and Neck Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan (Dr Onitsuka); Department of Otolaryngology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (Dr Fujii); Department of Head and Neck, Cancer Institute Hospital, Tokyo, Japan (Dr Kawabata); and Department of Head and Neck, National Cancer Center Hospital East, Chiba, Japan (Dr Saikawa).

June, 2006|Archive|

Folic Acid Supplementation May Have Role in Cancer Prevention

  • 6/24/2006
  • Iowa City, IA
  • staff

According to the results of a phase II clinical trial conducted in Italy, supplementation with folic acid resulted in the complete disappearance of precancerous changes to the larynx in 28% of patients and partial disappearance of precancerous changes to the larynx in 44% of patients. These results were published in the journal Cancer .

Approximately 40,000 people in the U.S. are diagnosed with head and neck cancer every year. Cancers of the head and neck include several types of cancers affecting the nasal cavity and sinuses, oral cavity, nasopharynx (upper part of throat, behind ear), oropharynx (middle part of throat, including soft palate, base of tongue, and tonsils), larynx, and other sites throughout the head and neck.

Laryngeal leucoplakia refers to precancerous changes to the larynx. The larynx is the area of the throat that contains the vocal cords. It aids in talking, swallowing, and breathing and is sometimes referred to as the voice box. If untreated, laryngeal leucoplakia can progress to laryngeal cancer.

Folate is a water-soluble B vitamin found in fresh fruits and vegetables. Folate, or supplementation with its synthetic form—folic acid—has been thought to play a role in cancer prevention. If confirmed, this would be an important finding since many people in the U.S. are folate deficient. Furthermore, folic acid supplementation is believed to be safe and non-toxic.

To evaluate the potential role of folic acid supplementation in the prevention of head and neck cancers, researchers in Italy conducted a phase II clinical trial among 43 patients with laryngeal leucoplakia. Patients received 5 mg of folic acid three times a day for six months.

Laryngeal leucoplakia disappeared completely in 28% of patients and disappeared partially in 44% of patients. Twenty-eight percent of patients had no response to folic acid supplementation.
Patients who had low folate levels at the start of the study were the most likely to respond to folic acid supplementation.
The researchers conclude that folic acid supplementation may reduce the risk of cancer progression, particularly in patients with folate deficiency. The researchers are now planning to conduct a clinical trial to assess whether folic acid supplementation can reduce the risk of recurrence among patients treated for laryngeal leucoplakia.

Aldmadori G, Bussu F, Navarra P et al. Pilot Phase IIA Study for Evaluation of the Efficacy of Folic Acid in the Treatment of Laryngeal Leucoplakia. Cancer. 2006; Early Online Publication June 12, 20.

June, 2006|Archive|

Access Pharmaceuticals Announces Clinical Results of MuGard(TM) at a Major Supportive Care Conference

  • 6/24/2006
  • Dallas, TX
  • press release

Access Pharmaceuticals, today announced the clinical results of MuGard(TM) at the 18th International Symposium of the Multinational Association of Supportive Care in Cancer in Toronto, June 22-24. MuGard(TM) is Access’ proprietary oral rinse product for the prevention and treatment of oral mucositis, the debilitating side-effect which afflicts more than 20% of cancer patients undergoing radiation and chemotherapy. Access plans to submit a 510(k) application for U.S. marketing approval of MuGard(TM) in the third quarter of this year.

“In our clinical study of head and neck cancer patients receiving radiation therapy, 47% of patients using MuGard(TM) had no mucositis,” stated Rosemary Mazanet M.D., Ph.D., CEO of Access. “Historically, patients on the same treatment without MuGard(TM) had a high rate of mucositis, with only 7% of patients experiencing no mucositis. In addition, the number of patients with mild to moderate mucositis was statistically reduced as well by the use of MuGard(TM). There is currently no well-accepted treatment for mucositis, and we believe that these results demonstrate that MuGard(TM) should be a valuable supportive care option for cancer patients.” The Company is actively seeking marketing partners for this product.

June, 2006|Archive|

Hartford Courant Examines Potential for HPV Vaccine Gardasil To Prevent Oral Cancer

  • 6/24/2006
  • Menlo Park, CA
  • staff

The Hartford Courant on Wednesday examined how Merck’s human papillomavirus vaccine Gardasil could prevent oral cancer, as at least one-quarter of oral cancer cases might be linked to HPV (Waldman, Hartford Courant, 6/21).

FDA earlier this month approved Gardasil — which is given in three injections over six months and will cost $360 — for sale and marketing to girls and women ages nine to 26. According to Merck, Gardasil in clinical trials has been shown to be 100% effective in preventing infection with HPV strains 16 and 18 — which together cause about 70% of cervical cancer cases — in women who do not already have HPV. In addition, the vaccine was shown to be about 99% effective in preventing HPV strains 6 and 11, which together with strains 16 and 18 cause about 90% of genital wart cases (Kaiser Daily Women’s Health Policy Report, 6/19).

Johns Hopkins University researchers in 2000 found that 25% of 253 people who were living with head and neck tumors were also positive for HPV strain 16. Although no firm connection between sexual practices such as kissing and oral sex has been made, some studies suggest such a connection between being positive for HPV and the tumors, according to the Courant.

Cancerous tumors that are positive for strains of HPV most commonly appear in the throat and tonsils and seem to be more responsive to treatment than cancer tumors that are negative for HPV, the Courant reports. About 30,000 people are diagnosed with oral cancer in the U.S. annually.

Hartford Courant, 6/21

June, 2006|Archive|

Taste Loss and Recovery Following Radiation Therapy

  • 6/24/2006
  • Gainesville, FL
  • P.L. Sandow et al.
  • This Article

Previous investigators have reported deficits in taste acuity in patients following radiation therapy for oropharyngeal cancer. In the present longitudinal study, 13 patients (mean age = 51.6 yrs) received conventional or hyperfractionated radiotherapy (63–76.8 Gy) for primary tumors of the oropharynx. One or both parotid glands and at least two-thirds of the tongue were included in the radiation field.

Smell recognition and taste detection thresholds were determined at baseline, 1 month, 6 months, and 1 year post-radiation. Differences for smell recognition and the 4 taste qualities were assessed (independently) at the 4 time intervals, with a one-way ANOVA. Smell recognition was unaffected by radiation. There were significant elevations in thresholds for sweet (p < 0.005), salty (p < 0.005), bitter (p < 0.005), and sour (p< 0.001) during radiation therapy that were restored to baseline levels at 6 months and 1 year after radiation. This study demonstrated that radiation-induced taste deficits can be recovered by 6 months.

June, 2006|Archive|

Heads Up! — A Call for Dentists to Screen

  • 6/23/2006
  • Vancouver, British Columbia, Canada
  • Catherine F. Poh et al.
  • J Can Dent Assoc2006; 72(5):413–6

The first solid evidence that periodic screening of the oral cavity can reduce mortality from oral cancer was published recently in Lancet.1 The article described a large population-based study of about 168,000 participants in India, 87,655 of whom received at least one visual oral screening examination. Over a 9-year period, a 32% reduction in mortality was observed among those screened. These data, along with new advances in screening technologies, support a call to dentists to commit to oral cancer screening as part of routine daily practice.

Globally, survival rates for those with oral cancer have changed little over the last 3 decades. The disease is often identified at an advanced stage, significantly reducing the probability of successful treatment. Half of oral cancer patients die within 5 years of diagnosis. Early detection of the disease (stages I and II) is associated with a vast improvement in survival rate; 80% of patients survive for 5 years compared with 20% of those with advanced disease (stages III and IV).2

The typically late diagnosis of oral cancer is ironic because the oral cavity is readily accessible for screening, and visible changes in the mucosa (in most cases) are associated with development of the disease. Oral cancer is frequently preceded by an identifiable premalignant lesion and the progression from dysplasia to cancer occurs over years.3 This should allow clinicians an opportunity to detect early changes. Nevertheless, most oral cancers are still detected at a late stage, when treatment is complex, costly, often disfiguring and marked by poor outcome.

It is well known that oral cancer is strongly associated with tobacco and alcohol consumption, together responsible for about 75% of oral cancers in the western world. When these 2 factors are combined, the risk is multiplied.4 Moreover, 90% of oral cancers occur in people over 45 years of age. Noteworthy, however, is a universally observed trend toward an increase in the number of younger adults without apparent risk, who develop the disease.5 This trend supports the extension of oral cancer screening to include all adults.

Dentists in Canada could play a major role in early detection of this fatal disease. An early study in British Columbia, undertaken over 20 years ago, showed that regular dental care strongly influenced the early diagnosis of oral cancer.6,7 Of 158 patients studied, 46% of those with regular dental care (at least one visit annually over the preceding 5 years) had stage I (early) tumours and 12% had stage IV (advanced). In contrast, 19% of patients without regular dental care had stage I tumours and 43% had stage IV tumours. We are now conducting a study to further define this association in patients with precancer and oral cancer referred to the British Columbia Cancer Agency. Among the first 40 patients interviewed, 34 (85%) reported that they either had their lesions identified by dental practitioners initially or sought the care of dental practitioners after self-identification of the lesions.

Given the potential for dentists to serve as frontline advocates, why has there been so little change in the stage of identification of this disease? A major challenge has been differentiating between benign and precancerous or early cancerous mucosal changes when there are often no distinctive clinical features that separate the conditions. This often results in diagnostic delay. Fortunately, help may be on the way! Recent research supports the use of diagnostic aids to facilitate a clinical decision.

Toluidine blue has a long history of use as a vital stain to identify oral cancers and has been used sporadically in dental practice for years. Historically, this stain has been less reliable in the identification of premalignant disease. New data from an ongoing longitudinal study being conducted at the British Columbia Cancer Agency have shown that premalignant oral lesions that stain positively are 6 times more likely to become oral cancers than those that do not stain. This finding supports a new role for this vital stain in identification of high-risk oral lesions.8

Another recent focus has been on the use of tissue fluorescence to identify alterations in biochemistry and morphology that may be associated with the development of oral cancer (Fig. 1b).9 This technique has a long history of use at other body sites, facilitating the identification of cancers and premalignant lesions in the lung and cervix. A simple hand-held device, the VELscope (LED Dental Inc., Vancouver, B.C.), has recently been developed for use by dentists to visualize tissue fluorescence in the oral cavity directly.10,11 A blue light is directed at the surface of the oral mucosa. Normal tissue will fluoresce and appear pale green. Abnormal tissue loses this fluorescence and appears dark brown to black. A pilot study of 44 patients has had encouraging results. In this group, the device achieved a sensitivity of 98% and a specificity of 100% when discriminating normal mucosa from tissue with biopsy-proven severe dysplasia, carcinoma in situ or invasive carcinoma.9

It is vitally important to recognize that the use of any visual aid is an adjunct to the conventional head and neck examination. There is no replacement for this important examination! Table 1 presents a simple systematic approach to a brief but thorough head and neck examination as a guide for students and residents in training. It is also a refresher for the practicing dentist.
Table 1

A. History taking
I. Family history of head and neck cancer
II. Review of oral habits and lifestyle
Obtain background information related to risk for oral cancer, including tobacco use, alcohol consumption and dietary or nutritional status.

III. Pertinent signs and symptoms
Identification of a persistent white patch in the mouth, a nonhealing ulcer, a lump or bump, submucosal fibrosis, spontaneous or unexpected oral bleeding, paresthesia, dysphagia or trismus warrants further investigation. If any of these conditions persists for more than 3 weeks following removal of identified etiologic factors, re-evaluation or referral for further investigation (or both) is recommended

B. Visual inspection
Equipment required for visual inspection includes a tongue depressor or mouth mirror, gauze and a good light source.

I. Extraoral examination
1. Position patient in an upright sitting position.
2. Inspect the head and neck region for asymmetry, swellings or other discrepancies.
3. Palpate the submandibular, neck and supraclavicular regions for lymph nodes.
4. Inspect and palpate lips and perioral tissues.

II. Intraoral examination
1. Position the patient in a semi-reclined position.

2. Examine all oral soft tissues sequentially.
• Buccal and labial mucosa
• Mandibular buccal and lingual gingiva and retromolar pad (trigone)
• Maxillary buccal and palatal gingiva
• Hard and soft palate, tonsillar tissues and uvula
• Floor of mouth (including the mandibular lingual vestibule)
• Tongue — dorsal, lateral and ventral surfaces

3. Make note of any tissue swellings, changes in colour, texture, symmetry, areas of tenderness or changes in tissue mobility.

4. Examine visually and palpate the most common anatomical sites of oral cancer — the ventral–lateral tongue, floor of mouth and soft palate complex — to identify leukoplakia, erythroplasia, ulceration, induration, fibrotic submucosal bands or a palpable mass. These are the sites of 60% of cancers of the oral cavity.

C. Visualization aids
Techniques to enhance visualization of premalignant lesions and oral cancers are garnering considerable research and media attention. Those currently being evaluated are toluidine blue and fluorescence visualization (the VELscope).

Oral cancer is the sixth most common cancer in the world and is a devastating disease with terrible consequences to the individual and to society. Approximately 3,200 new oral cancers and 1,050 deaths from oral cancer are estimated to occur each year in Canada.12 The integration of an oral cancer screening examination into daily practice requires little additional time or expense in an already busy practice. The challenge to the dental profession is to ensure that all adult patients have a brief but regular oral cancer screening examination.

Working together with a strong commitment to change, dentists have the opportunity to make a dramatic difference. The World Health Organization has made a commitment to take action against the neglected burden of oral cancer, mainly by emphasizing prevention. The call to action in Canada requires a personal response to this need from each of the more than 18,000 dentists in the country13 and facilitation of change by dental societies through the provision of education. It also represents a challenge to our dental schools to introduce and reinforce the value of incorporating an oral cancer screening examination into the daily practice of the 500–600 dental students who graduate each year.

1. Sankaranarayanan R, Ramadas K, Thomas G, Muwonge R, Thara S, Mathew
B, and other. Effect of screening on oral cancer mortality in Kerala, India: a cluster-randomised controlled trial. Lancet 2005; 365(9475):1927–33.

2. Cancer facts and figures 2005. Atlanta: American Cancer Society; 2005. Available from: URL:

3. Rosin MP, Cheng X, Poh C, Lam WL, Huang Y, Lovas J, and others. Use of allelic loss to predict malignant risk for low-grade oral epithelial dysplasia. Clin Cancer Res 2000; 6(2):357–62.

4. National Cancer Institute. Surveillance, epidemiology, and end results program public-use data, 1973–1998. Rockville, MD: National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Cancer Statistics Branch; Released April 2001, based on the August 2000 submission. Available from: URL:

5. Schantz SP, Yu GP. Head and neck cancer incidence trends in young
Americans, 1973–1997, with a special analysis for tongue cancer. Arch
Otolaryngol Head Neck Surg 2002; 128(3):268–74.

6. Elwood JM, Gallagher RP. Factors influencing early diagnosis of cancer of the oral cavity. CMAJ 1985; 133(7):651–6.

7. Elwood JM, Gallagher RP. Dental surveillance produces earlier diagnosis of oral cavity cancers. J Can Dent Assoc 1986; 52(10):845–7.

8. Zhang L, Williams PM, Poh CF, Laronde D, Epstein JB, Durham S, and others. Toluidine blue staining identifies high-risk primary oral premalignant lesions with poor outcome. Cancer Res 2005; 65(17):8017–21.

9. Lane PM, Gilhuly T, Whitehead P, Zeng H, Poh C, Ng S, and others. Simple device for the direct visualization of oral-cavity tissue fluorescence. J Biomed Optic 2006; 11(2):024006.

10. Poh CF, Ng SP, Williams PM, Zhang L, Laronde DM, Lane P, and others. Detection of clinically occult high-risk oral premalignant disease using direct autofluorescence visualization. Head Neck 2006. In press.

11. Ng S, Poh C, Williams PM, Zhang L, Laronde D, MacAulay C, and other. Multi-spectral fluorescent visualization (FV) as a visual aid to identify high-risk oral premalignant lesions (OPLs). In: Proceedings of American Association for Cancer Research, 96th Annual Meeting; 2005 Apr. 16–20; Anaheim, CA.
Philadelphia. Abstract No. 3850.

12. Canadian cancer statistics 2005. Toronto: Canadian Cancer Society, National Cancer Institute of Canada, Public Health Agency of Canada, Statistics Canada; 2005. Available from: URL:

13. Health personnel trends in Canada, 1993–2002. Ottawa: Canadian Institute for Health Information; 2004. Available from: URL:

Catherine F. Poh, DDS, PhD, Cert Oral Path, FRCD(C);
P. Michele Williams, BSN, DMD, Cert Oral Med, FRCD(C);
Lewei Zhang, DDS, PhD, Dip Oral Path, FRCD(C);
Miriam P. Rosin, PhD

Authors’ affiliations:
Dr. Poh is clinical assistant professor in the faculty of dentistry,
University of British Columbia and staff, British Columbia
Cancer Agency, Vancouver, British Columbia.

Dr. Williams is clinical assistant professor in the faculty of
dentistry, University of British Columbia and staff in the oral
oncology department, British Columbia Cancer Agency.

Dr. Zhang is professor and director of oral medicine and
oral pathology in the faculty of dentistry, University of British

Dr. Rosin is professor and director of the BC Oral Cancer
Prevention Program, British Columbia Cancer Agency.

June, 2006|Archive|

Patterns of lymph node spread of cutaneous squamous cell carcinoma of the head and neck

  • 6/22/2006
  • Sydney, Australia
  • Tom J Vauterin et al.
  • Head Neck, June 16, 2006

Among patients with cutaneous squamous cell carcinoma (SCC) of the head and neck, recent studies have shown that those with involvement of the parotid gland also have a high incidence of neck node involvement. Treatment of the neck by either surgery or radiotherapy is therefore recommended among patients with parotid SCC, even if clinical examination is negative. The aim of this study was first to analyze patterns of metastatic spread in the parotid and cervical lymph nodes and then to correlate the pattern of involved nodes with the primary cutaneous site in order to guide the appropriate extent of surgery, should neck dissection be used to treat the neck in patients with parotid SCC.

A cohort of 209 patients with cutaneous SCC of the head and neck and clinically evident regional metastatic disease was reviewed retrospectively from 3 Australian institutions. The distribution of involved nodes was obtained from pathology reports; the anatomic sites of primary cutaneous cancers were then correlated with these findings.

Among 209 patients, 171 (82%) had clinical parotid involvement. Of these, 28 had clinical neck disease, whereas 143 had parotid disease alone. Thirty-eight (18%) patients had neck disease only. A total of 199 patients were treated surgically, whereas 10 received radiotherapy alone. Surgery included 172 parotidectomies and 151 neck dissections (93 of which were elective). Primary sites were cheek (21.7%), pinna (20.4%), temple (15.8%), forehead (15.8%), postauricular region (5.9%), neck (5.3%), anterior scalp (5.3%), posterior scalp (3.3%), periorbital (3.3%), nose (2.6%), and chin (0.6%). Among pathologically positive necks, level II was most frequently involved (79%). Level IV (13%) and level V (17%) were only involved in extensive lymph node disease, the exception being for isolated level V metastases from the posterior scalp.

Primary sites were mainly localized to the lateral aspect of the head. Among patients with cutaneous SCC involving the parotid and neck, level II was the most commonly involved neck level. The distribution of involved nodes suggests that in a patient with parotid involvement and a clinically negative neck with an anterolateral primary, a supraomohyoid neck dissection, always including the external jugular lymph node(s) would be appropriate. In the case of a posterior primary, level V should be dissected as well. In patients with parotid SCC and a clinically positive neck, a comprehensive neck dissection is recommended.

Tom J Vauterin, Michael J Veness, Garry J Morgan, Michael G Poulsen, and Christopher J O’brien

Authors’ affililation:
Sydney Head and Neck Cancer Institute and Sydney Cancer Centre, Royal Prince Alfred Medical Centre and University of Sydney, Sydney, Australia

June, 2006|Archive|