What is included in the physical exam for tumor metastasis in cutaneous squamous cell carcinoma (cSCC)?

Updated: Jul 08, 2020
  • Author: Talib Najjar, DMD, MDS, PhD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Investigate regional spread of head and neck cSCC by palpating for enlarged preauricular, submandibular, and cervical lymph nodes. Regional metastasis occurs in 2-6% of cases of cSCC. The risk of metastasis correlates roughly with tumor size and differentiation. In general, metastasis from cSCC of the forehead, temples, eyelids, cheeks, and ears is to the parotid nodes; metastasis from cSCC of the lips and perioral region is primarily to the submental and submaxillary (upper cervical) nodes.

Rarely, cSCC presents as a parotid or neck mass because of lymphatic spread from an occult cutaneous lesion or remotely treated skin cancer (see the image below). [38] The median time from initial treatment to presentation with a parotid or neck mass ranges from 10 to 13 months. Fine-needle aspiration biopsy can be of assistance in the evaluation of any mass suspected to represent occult metastasis.

Preauricular and helical scars (black arrows) from Preauricular and helical scars (black arrows) from prior excisions are noted in a patient who presented with cervical metastases (white arrow) from an occult cutaneous squamous cell carcinoma.

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