Management of the Neck for Non-melanoma Skin Cancer

Abstract

Purpose of Review

To summarize the current management of the neck lymph node basin for head and neck non-melanoma skin cancers.

Recent Findings

Over the last 5 years, there have been updates to staging for cSCC and MCC. T classification of the AJCC staging system has been changed to match the UICC staging system. MCC staging has been updated based on data from the National Cancer Data Base. Sentinel lymph node biopsy, while established in MCC, is playing a growing role in the management of high-risk N0 cSCC.

Summary

The optimal management of N0 neck varies by metastatic potential. In low-risk malignancy, no workup is necessary. In cSCC, risk stratification is necessary. High-risk tumors with N0 necks should undergo preoperative imaging with CT and targeted FNA of suspicious lymph nodes. If radiologically negative, a SLNB should be considered. Selective neck dissection should be performed for N+ disease and positive SLNB. Elective neck dissection is not routinely recommended and should be reserved for positive parotid nodal disease. Merkel cell carcinoma has high rates of nodal metastases and requires preoperative imaging with targeted FNA of suspected metastases. SLNB should be performed for N0 disease to guide prognostication and further treatment. Management of negative SLN is controversial, and most can be observed while radiation may be considered for high-risk patients. Positive SLN requires completion neck dissection and radiation.

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