Utility of head and neck cutaneous squamous cell carcinoma sentinel node biopsy: a systematic review

Otolaryngol Head Neck Surg. 2014 Feb;150(2):180-7. doi: 10.1177/0194599813511949. Epub 2013 Nov 7.


Objective: Sentinel lymph node biopsy (SLNB) is standard of care for melanoma, but its role in cutaneous squamous cell carcinoma (cSCC) has not been established. Study objectives include: (1) analyze the feasibility and reliability SLNB for head and neck (H&N) cSCC and (2) identify risk factors associated with a positive SLN.

Data sources: MEDLINE, PubMed, Cochrane, and ASCO databases searches conducted (1946-2013).

Review methods: Using the PRISM model, a comprehensive systematic review of H&N cSCC SLNB studies with associated recurrence rates was conducted. Dual-blinded data extraction identify primary outcomes (successful SLN harvest and false omission rate) and secondary outcomes (risk factors associated with a +SLN).

Results: Two hundred twenty-one articles were screened; 73 patients from 11 publications met inclusion criteria (3 case series; 8 prospective cohorts). Studies ranged from 1 to 15 patients (median 5). Median age was 74 years. Median follow-up was 21.5 months. Average tumor size was 3.09 cm. At least 1 SLN was identified in 100% of patients (median 2). Ten (13.5%) had a positive SLN; no additional metastatic nodes were identified in 9 patients receiving completion lymphadenectomy. Tumor diameter was not associated with SLN status (P = .09; 95% CI, -.27 to 3.02). Risk factors (tumor depth, perineural invasion, location, differentiation) were not consistently recorded. Three of 63 (4.76%) failed regionally following a negative SLNB.

Conclusion: H&N cSCC SLNB is feasible and reliable for staging, with a false omission rate of 4.7% mirroring melanoma. Prospective studies documenting high risk features are required to further define its role.

Keywords: cutaneous squamous cell carcinoma; sentinel node; skin cancer.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Carcinoma, Squamous Cell / epidemiology
  • Carcinoma, Squamous Cell / pathology*
  • Carcinoma, Squamous Cell / radiotherapy
  • Feasibility Studies
  • Head and Neck Neoplasms / epidemiology
  • Head and Neck Neoplasms / pathology*
  • Head and Neck Neoplasms / radiotherapy
  • Humans
  • Lymph Node Excision
  • Neoplasm Invasiveness
  • Neoplasm Recurrence, Local / epidemiology
  • Radiotherapy, Adjuvant
  • Reproducibility of Results
  • Risk Factors
  • Sensitivity and Specificity
  • Sentinel Lymph Node Biopsy* / methods
  • Sentinel Lymph Node Biopsy* / standards
  • Skin Neoplasms / epidemiology
  • Skin Neoplasms / pathology*
  • Skin Neoplasms / radiotherapy
  • Squamous Cell Carcinoma of Head and Neck