Subscribe to RSS
DOI: 10.1055/a-1953-7374
Kutane Plattenepithelkarzinome im Kopf- und Halsbereich
Cutaneous squamous cell carcinoma of the head and neckZusammenfassung
Hintergrund Das kutane Plattenepithelkarzinom (kPEK) als weltweit zweithäufigster Hauttumor ist überwiegend an Kopf und Gesicht lokalisiert. Aufgrund der steigenden Anzahl älterer Menschen und der dadurch zunehmenden Inzidenz gewinnt es in den letzten Jahren an Relevanz im HNO-Fachgebiet.
Material und Methoden Diese Übersichtsarbeit basiert auf einer selektiven Literaturrecherche in PubMed, der deutschen und europäischen Leitlinie sowie klinikeigenen Erfahrungen.
Ergebnisse Ätiologisch ist neben der chronischen UV-Exposition eine Störung des körpereigenen Abwehrsystems zunehmend bedeutend. Die vertikale Tumordicke ist mit dem höchsten Risiko einer Metastasierung und eines Lokalrezidivs assoziiert. Weitere bedeutende Risikofaktoren sind: horizontaler Tumordurchmesser, Entdifferenzierung, Desmoplasie, perineurales Wachstum und Lokalisation im Gesicht. Zumeist ist die Exzision mit histologischer Schnittrandkontrolle als Therapie ausreichend. Bei klinischem Verdacht auf lokoregionäre Metastasen sollen je nach Lokalisation des Primärtumors die drainierenden zervikalen Lymphknotenlevel ausgeräumt werden. kPEK der oberen Gesichtshaut und der Ohrmuschel metastasieren bevorzugt zuerst in die Glandula parotidea. Mit der Zulassung des PD-1-Antikörpers Cemiplimab in Europa steht erstmals ein Wirkstoff zur Behandlung fortgeschrittener, chirurgisch oder durch Strahlentherapie nicht therapierbarer kPEK zur Verfügung.
Schlussfolgerungen Die grundsätzlich sehr niedrige Mortalität des kPEK erhöht sich erheblich, wenn Metastasen auftreten. Dementsprechend sollen sich bildgebende Verfahren, chirurgische Therapie und Nachsorgeintervalle an den Risikofaktoren orientieren. Hierdurch können Metastasen oder Lokalrezidive frühzeitig erkannt und die Prognose verbessert werden.
Abstract
Objective Cutaneous squamous cell carcinoma (cSCC), predominantly located on the scalp and face, is the second most prevalent skin cancer globally. Due to the increasing elderly population and rising incidence of cSCC, it has been gaining relevance in otorhinolaryngology.
Material and Methods This review article is based on a selective PubMed literature search, German and European guidelines and the clinic's own experience.
Results In addition to chronic UV exposure, a disruption of the body's own immune system is becoming increasingly important. Vertical tumor thickness is associated with the highest risk of metastatic spread and local recurrence. Other significant risk factors are: horizontal tumor diameter, dedifferentiation, desmoplasia, perineural growth and localization on the face. Most cases are manageable by local excision with histological control of the excision margins. If regional metastases are clinically suspected, the draining cervical lymph node levels should be dissected depending on primary tumor location. cSCC of the upper face and the auricle primarily metastasize to the parotid gland. With the approval of the PD-1-blocking antibody cemiplimab in Europe, an active ingredient has been made available for the treatment of advanced cSCC where surgery or radiotherapy are no longer an option.
Conclusions The otherwise very low mortality rate of cSCC increases considerably with metastases. Therefore, imaging, surgical therapy and follow-up intervals should be based on risk factors. This allows early detection of metastases or local recurrences and improves the prognosis.
Schlüsselwörter
Kopf-Hals-Tumore - kutanes Plattenepithelkarzinom - Staging - parotideale Metastasen - Immuncheckpoint-InhibitorKeywords
head and neck cancer - cutaneous squamous cell carcinoma - staging - parotid metastasis - checkpoint-inhibitorPublication History
Received: 10 January 2022
Accepted after revision: 22 August 2022
Article published online:
01 December 2022
© 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF). S3-Leitlinie Aktinische Keratose und Plattenepithelkarzinom der Haut, Langversion 1.1, 2020, AWMF Registernummer: 032/022OL. https://www.leitlinienprogrammonkologie.de/leitlinien/aktinische-keratosen-und-plattenepithelkarzinom-der-haut/
- 2 Stratigos AJ, Garbe C, Dessinioti C. et al. European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 1. epidemiology, diagnostics and prevention. Eur J Cancer 2020; 128: 60–82 DOI: 10.1016/j.ejca.2020.01.007.
- 3 Stratigos AJ, Garbe C, Dessinioti C. et al. European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 2. Treatment. Eur J Cancer 2020; 128: 83-102 DOI: 10.1016/j.ejca.2020.01.008.. (PMID: 32113942)
- 4 Robert Koch-Institut (Hrsg) und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. (Hrsg). Krebs in Deutschland für 2015/2016. In: . 12. Ausgabe. Berlin: Robert Koch-Institut, Berlin; 2019: 68-69
- 5 Green AC, Olsen CM. Cutaneous squamous cell carcinoma: an epidemiological review. Br J Dermatol 2017; 177: 373-381 DOI: 10.1111/bjd.15324. (PMID: 28211039)
- 6 Silberstein E, Sofrin E, Bogdanov-Berezovsky A. et al. Lymph node metastasis in cutaneous head and neck squamous cell carcinoma. Dermatol Surg 2015; 41: 1126-1129 DOI: 10.1097/DSS.0000000000000488. (PMID: 26372123)
- 7 Que SKT, Zwald FO, Schmults CD. Cutaneous squamous cell carcinoma: incidence, risk factors, diagnosis, and staging. J Am Acad Dermatol 2017; 78: 237-247 DOI: 10.1016/j.jaad.2017.08.059. (PMID: 29332704)
- 8 Thompson AK, Kelley BF, Prokop LJ. et al. Risk factors for cutaneous squamous cell carcinoma recurrence, metastasis, and disease-specific death: a systematic review and meta-analysis. JAMA Dermatol 2016; 152: 419-428 DOI: 10.1001/jamadermatol.2015.4994. (PMID: 26762219)
- 9 Brantsch KD, Meisner C, Schönfisch B. Analysis of risk factors determining prognosis of cutaneous squamous-cell carcinoma: a prospective study. Lancet Oncol 2008; 9: 713-720 DOI: 10.1016/S1470-2045(08)70178-5. (PMID: 18617440)
- 10 Eigentler TK, Leiter U, Häfner HM. et al. Survival of patients with cutaneous squamous cell carcinoma: results of a prospective cohort study. J Invest Dermatol 2017; 137: 2309-2315 DOI: 10.1016/j.jid.2017.06.025. (PMID: 28736229)
- 11 Fox M, Brown M, Golda N. et al. Nodal staging of high-risk cutaneous squamous cell carcinoma. J Am Acad Dermatol https://pubmed.ncbi.nlm.nih.gov/30227190/ 2019; 81: 548-557 DOI: 10.1016/j.jaad.2018.09.006. (PMID: 30227190)
- 12 Liao LJ, Lo WC, Hsu WL. et al. Detection of cervical lymph node metastasis in head and neck cancer patients with clinically N0 neck – a meta-analysis comparing different imaging modalities. BMC Cancer 2012; 12: 236 DOI: 10.1186/1471-2407-12-236. (PMID: 22691269)
- 13 Hohlweg-Majert B, Metzger MC, Voss PJ. et al. Preoperative cervical lymph node size evaluation in patients with malignant head/neck tumors: comparison between ultrasound and computer tomography. J Cancer Res Clin Oncol 2009; 135: 753-759 DOI: 10.1007/s00432-008-0487-y. (PMID: 18830710)
- 14 Bree R, Takes RP, Castelijns JA. et al. Advances in diagnostic modalities to detect occult lymph node metastases in head and neck squamous cell carcinoma. Head Neck 2015; 37: 1829-1839 DOI: 10.1002/hed.23814. (PMID: 24954811)
- 15 Traylor KS, Koontz N, Mosier K. Squamous cell carcinoma: PET/CT and PET/MRI of the pretreatment and post-treatment neck. Semin Ultrasound CT MR 2019; 40: 400-413 DOI: 10.1053/j.sult.2019.07.004. (PMID: 31635767)
- 16 Piao Y, Bold B, Tayier A. et al. Evaluation of 18F-FDG PET/CT for diagnosing cervical nodal metastases in patients with oral cavity or oropharynx carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108: 933-938 DOI: 10.1016/j.tripleo.2009.07.054. (PMID: 19846326)
- 17 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Diagnostik und Therapie des Mundhöhlenkarzinoms, Langversion 3.0, 2021, AWMF Registernummer: 007/100OL. https://www.leitlinienprogrammonkologie.de/leitlinien/mundhoehlenkarzinom/
- 18 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): Diagnostik, Therapie und Nachsorge des Larynxkarzinoms, Langversion 1.1, 2019, AWMF-Registernummer: 017/076OL. http://www.leitlinienprogrammonkologie.de/leitlinien/larynxkarzinom/
- 19 Breuninger H, Konz B, Burg G. Mikroskopisch kontrollierte Chirurgie bei malignen Hauttumoren. Dtsch Arztebl 2007; 104: 427-432
- 20 Kofler L, Kofler K, Schulz C. et al. Sentinel lymph node biopsy for high-thickness cutaneous squamous cell carcinoma. Arch Dermatol Res 2021; 313: 119-126 DOI: 10.1007/s00403-020-02082-1. (PMID: 32385689)
- 21 Tejera-Vaquerizo A, García-Doval I, Llombart B. et al. Systematic review of the prevalence of nodal metastases and the prognostic utility of sentinel lymph node biopsy in cutaneous squamous cell carcinoma. J Dermatol 2018; 45: 781-790 DOI: 10.1111/1346-8138.14342. (PMID: 29701281)
- 22 Hirshoren N, Ruskin O, McDowell LJ. et al. Management of parotid metastatic cutaneous squamous cell carcinoma: regional recurrence rates and survival. Otolaryngol Head Neck Surg 2018; 159: 293-299 DOI: 10.1177/0194599818764348. (PMID: 29533706)
- 23 Cheng J, Yan S. Prognostic variables in high-risk cutaneous squamous cell carcinoma: a review. J Cutan Pathol 2016; 43: 994-1004 DOI: 10.1111/cup.12766. (PMID: 27404896)
- 24 Myers LL, Ahn C. Cutaneous squamous cell carcinoma metastasis to the parotid region lymph nodes. Laryngoscope 2018; 129: 1579-1586 DOI: 10.1002/lary.27534. (PMID: 30444261)
- 25 Wang JT, Palme CE, Wang AY. et al. In patients with metastatic cutaneous head and neck squamous cell carcinoma to cervical lymph nodes, the extent of neck dissection does not influence outcome. J Laryngol Otol 2013; 127: S2-S7 DOI: 10.1017/S0022215112002101.
- 26 Vauterin TJ, Veness MJ, Morgan GJ. et al. Patterns of lymph node spread of cutaneous squamous cell carcinoma of the head and neck. Head Neck 2006; 28: 785-791 DOI: 10.1002/hed.20417. (PMID: 16783833)
- 27 Ebrahimi A, Moncrieff MD, Clark JR. et al. Predicting the pattern of regional metastases from cutaneous squamous cell carcinoma of the head and neck based on location of the primary. Head Neck 2010; 32: 1288-1294 DOI: 10.1002/hed.21332. (PMID: 20091686)
- 28 Gurney B, Newlands C. Management of regional metastatic disease in head and neck cutaneous malignancy. 1. Cutaneous squamous cell carcinoma. Br J Oral Maxillofac Surg 2014; 52: 294-300 DOI: 10.1016/j.bjoms.2014.01.015. (PMID: 24559975)
- 29 Teymoortash A, Werner JA. Current advances in diagnosis and surgical treatment of lymph node metastasis in head and neck cancer. Laryngorhinootologie 2012; 91: S102-122 DOI: 10.1055/s-0031-1297243. (PMID: 22456914)
- 30 O'Brien CJ, McNeil EB, McMahon JD. et al. Significance of clinical stage, extent of surgery, and pathologic findings in metastatic cutaneous squamous carcinoma of the parotid gland. Head Neck 2002; 24: 417-422 DOI: 10.1002/hed.10063. (PMID: 12001070)
- 31 Thom JJ, Moore EJ, Price DL. et al. The role of total parotidectomy for metastatic cutaneous squamous cell carcinoma and malignant melanoma. JAMA Otolaryngol Head Neck Surg 2014; 140: 548-554 DOI: 10.1001/jamaoto.2014.352. (PMID: 24722863)
- 32 Olsen KD, Moore EJ. Deep lobe parotidectomy: clinical rationale in the management of primary and metastatic cancer. Eur Arch Otorhinolaryngol 2014; 271: 1181-1185 DOI: 10.1007/s00405-013-2616-8. (PMID: 23832259)
- 33 Lansbury L, Bath-Hextall F, Perkins W. et al. Interventions for non-metastatic squamous cell carcinoma of the skin: systematic review and pooled analysis of observational studies. BMJ 2013; 347: f6153 DOI: 10.1136/bmj.f6153. (PMID: 24191270)
- 34 Gellrich FF, Huning S, Beissert S. Medical treatment of advanced cutaneous squamous-cell carcinoma. J Eur Acad Dermatol Venereol 2019; 33: 38-43 DOI: 10.1111/jdv.16024. (PMID: 31833610)
- 35 Corchado-Cobos R, García-Sancha N, González-Sarmiento R. et al. Cutaneous Squamous Cell Carcinoma: From biology to therapy. Int J Mol Sci 2020; 21: 2956 DOI: 10.3390/ijms21082956. (PMID: 32331425)
- 36 Rischin D, Khushalani NI, Schmults CD. et al. Phase II study of cemiplimab in patients with advanced cutaneous squamous cell carcinoma (CSCC): Longer follow-up. J Clin Oncol 2020; 38 (Suppl. 15) 10018-10018 DOI: 10.1200/JCO.2020.38.15_suppl.10018.
- 37 Wessely A, Steeb T, Leiter U. et al. Immune checkpoint blockade in advanced cutaneous squamous cell carcinoma: what do we currently know in 2020?. Int J Mol Sci 2020; 21: 9300 DOI: 10.3390/ijms21239300. (PMID: 33291277)
- 38 Ishitsuka Y, Hanaoka Y, Tanemura A. et al. Cutaneous squamous cell carcinoma in the age of immunotherapy. Cancers 2021; 13: 1148 DOI: 10.3390/ijms21239300. (PMID: 33800195)