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High-Risk Cutaneous Squamous Cell Carcinoma of the Head and Neck: A Clinical Review

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Given the rapidly evolving nature of the field, the current state of “high-risk” head and neck cutaneous squamous cell carcinoma (HNcSCC) is poorly characterized.

Methods

Narrative review of the epidemiology, diagnosis, workup, risk stratification, staging and treatment of high-risk HNcSCC.

Results

Clinical and pathologic risk factors for adverse HNcSCC outcomes are nuanced (e.g., immunosuppression and perineural invasion). Frequent changes in adverse prognosticators have outpaced population-based registries and the variables they track, restricting our understanding of the epidemiology of HNcSCC and inhibiting control of the disease. Current heterogeneous staging and risk stratification systems are largely derived from institutional data, compromising their external validity. In the absence of staging system consensus, tumor designations such as “high risk” and “advanced” are variably used and insufficiently precise to guide management. Evidence guiding treatment of high-risk HNcSCC with curative intent is also suboptimal. For patients with incurable disease, an array of trials are evaluating the impact of immunotherapy, targeted biologic therapy, and other novel agents.

Conclusion

Population-based registries that broadly track updated, nuanced, adverse clinicopathologic risk factors, and outcomes are needed to guide development of improved staging systems. Design and development of randomized controlled trials (RCTs) in advanced-stage HNcSCC populations are needed to evaluate (1) observation, sentinel lymph node biopsy, or elective neck dissection for management of the cN0 neck, (2) indications for surgery plus adjuvant radiation versus adjuvant chemoradiation, and (3) the role of immunotherapy in treatment with curative intent. Considering these knowledge gaps, the authors explore a potential high-risk HNcSCC treatment framework.

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Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Flora Yan BA, Brittny N. Tillman MD, Erin M. Wynings MD, Rebecca Lee MD, Larry L. Myers MD & Andrew T. Day MD, MPH

  2. Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Rajiv I. Nijhawan MD & Divya Srivastava MD

  3. Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    David J. Sher MD, MPH & Vladimir Avkshtol MD

  4. Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Jade Homsi MD

  5. Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Justin A. Bishop MD

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  1. Flora Yan BA
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Appendix

Appendix

See Tables 6 and 7

Table 6 Detailed cutaneous squamous cell carcinoma (cSCC) primary tumor high-risk features or upstaging criteria according to staging systems and risk stratification dataa
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Table 7 High-risk features unique to the NCCN risk-stratification system and evidence from selected studiesa
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Yan, F., Tillman, B.N., Nijhawan, R.I. et al. High-Risk Cutaneous Squamous Cell Carcinoma of the Head and Neck: A Clinical Review. Ann Surg Oncol 28, 9009–9030 (2021). https://doi.org/10.1245/s10434-021-10108-9

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