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Video

Head and Neck Surgery

(A503) Additional Occult Nodal Metastasis in Regionally Metastatic Cutaneous Squamous Cell Carcinoma

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • Ayan Farah, BS

    Medical Student
    University of Missouri - Columbia School of Medicine
    Columbia, Missouri, United States

    • Co-Author(s)

  • Megan Gillespie, MD

    Resident Physician
    Department of Otolaryngology–Head & Neck Surgery, University of Missouri
    Columbia, Missouri, United States

  • Patrick T. Tassone, MD

    Patrick Tassone, MD
    University of Missouri-Columbia
    Columbia, Missouri, United States

    • Senior Author(s)

  • Patrick T. Tassone, MD

    Patrick Tassone, MD
    University of Missouri-Columbia
    Columbia, Missouri, United States

Disclosure(s):
Ayan Farah, BS: No relevant relationships to disclose.
Megan Gillespie, MD: No relevant relationships to disclose.
Patrick T. Tassone, MD: No relevant relationships to disclose.


Introduction: Patients with regionally metastatic cutaneous squamous cell carcinoma (cSCC) typically undergo lymphadenectomy followed by appropriately selected adjuvant therapy. Nodal levels at risk are often dissected electively at the time of removal of known metastatic disease. However, the incidence of occult metastasis to additional lymph nodes, factors associated with its occurrence, and its impact on oncologic outcomes remain poorly characterized.

Methods: A retrospective cohort study was conducted on patients who underwent lymphadenectomy for metastatic cSCC. Occult nodal metastasis was defined as pathologically positive lymph nodes not identified on preoperative examination or imaging. Logistic regression was used to identify patient factors associated with occult nodal metastasis. Cox proportional hazard analysis was used to identify factors associated with disease free and overall survival.

Results: Among 60 patients undergoing lymphadenectomy for cSCC, 29 (48%) had occult nodal metastasis in addition to their known metastatic disease. All patients underwent preoperative imaging, most commonly CT scan (n=47, 78%) and PET (n=47, 78%). Factors associated with occult nodal metastasis on both univariable and multivariable analysis were increasing age (OR 1.07, 95% CI 1.01-1.13, p=0.027) and primary tumor lymphovascular invasion (OR 16.4, 95% CI 2.58-328, p=0.013). Advanced T stage (HR 4.45, 95% CI 1.58-12.6, p=0.005) and adjuvant radiation therapy (HR 0.15, 95% CI 0.05-0.43, p< 0.001) were associated overall survival, but occult nodal metastasis was not (HR 1.08, 95% CI 0.41-2.08, p=0.88).

Conclusions: Additional occult nodal metastases are frequently observed in patients with known regionally metastatic cSCC. Patients with a older age and lymphovascular invasion were associated with an increased likelihood of occult metastases. Occult nodal metastasis was not associated with worse survival, whereas adjuvant radiation therapy was associated with a significant survival benefit.