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DOI: 10.1055/a-1953-7374
Kutane Plattenepithelkarzinome im Kopf- und Halsbereich
Cutaneous squamous cell carcinoma of the head and neck
Zusammenfassung
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
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