Neck management
In a systematic review of vestibule SCCs, the overall incidence of nodal
disease varied from 4 to 40% between series (18). This heterogeneity
explains the discrepancies noted between authors and their
recommendations of surveillance, elective nodal dissection or
prophylactic radiotherapy for the management of cN0 vestibule SCC
(7,13). Scurry et al. published a meta-analysis of nasal cavity
SCCs with and without prophylactic neck treatment, irrespective of the
type of treatment of the primary tumour. They observed a 18.1% rate of
regional recurrence, approaching the 20% cut-off, often cited as
suggestive of consideration for elective nodal treatment (17). Other
authors observed a significant association between tumour size or volume
and regional control (22,23). In our series, the rate of regional
recurrence was 13% despite the absence of prophylactic irradiation of
the neck for N0 disease.
Some authors advocate neck dissection only for cases of suspected
metastasis in early-stage lesions (7,9). Sentinel lymph node biopsy
could be developed in this indication, to select patients requiring a
neck dissection (25). Bouaouad et al. recommended treating lymph
nodes systematically and bilaterally for locally-advanced tumours,
either by neck dissection if cN+ or by RT if cN0, since they found
better regional control when bilateral neck prophylactic treatment was
performed (13). Treatment of the neck should at least include levels I,
II and III, however, metastasis to the pre-auricular, facial and
retropharyngeal lymph nodes are possible and should be considered
(13,18).