Background: The increased average age of the world population coupled with long-term sun exposure has led to an increase in the incidence of cutaneous squamous cell carcinoma (cSCC). The incidence of nodal metastasis in such patients is thought to range from less than 5% to up to 20% in some reports. Mortality rates following a metastasis have been shown to be high, demonstrating the importance of early detection of metastatic nodes. The aim of our study was to ascertain the value of a routine ultrasound scan (USS) for every patient following head and neck cSCC diagnosis in screening for metastatic disease.
Method: A 41 month retrospective analysis was carried out (January 2009–May 2012) involving all patients with cSCC treated by the OSMF Department at Prince Charles Hospital and the Royal Glamorgan Hospital in South Wales, UK. There were a total number of 108 incidences of cSCC. The following criteria were used in the data collection process: 1. Anatomical characteristics (site); 2. Pathological characteristics (size, depth, margins and differentiation); 3. Patient factors (immunosuppression); 4. USS findings.
Results: Of the 108 incidences, one patient was diagnosed with a metastatic lymph node following USS. This patient exhibited one of five metastatic risk factors and the node was clinically palpable meaning a USS would have been carried out as per the existing British Association of Dermatology guidelines.
Conclusion: The pick up rate of cervical lymph node metastasis from routine USSs of all cSCCs is not high enough to warrant the application of this investigation to all patients routinely. It should therefore be reserved for high-risk cases where it is felt that a scan is justified on clinical grounds. Work is underway to ascertain whether or not high risk cases would benefit from routine USS of the neck to detect early metastasis.