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This study determines predictors of delayed regional metastases in \u003C4 cm CSCC of the face and scalp. Methods: Retrospective review of tertiary academic head and neck clinic cases with regional metastasis occurring at least 6 months after primary CSCC (2012–2018). Results: 50 male patients; no initial neck nodes. Perineural invasion was the only predictor of delayed cervical lymph node recurrence; tumor size/depth and lymphovascular invasion were not associated. Conclusion: Perineural invasion predicts delayed regional lymph node metastasis and supports upstaging small CSCC to T3; prophylactic neck treatment should be considered, especially with immunotherapy.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/delayed-regional-metastasis-from-small-facescalp-cutaneous-squamous-carcinoma-outcomes-and-predictors/371408/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/delayed-regional-metastasis-from-small-facescalp-cutaneous-squamous-carcinoma-outcomes-and-predictors/371408.png","ImageObject",300,407,{"name":92,"@type":93},"Margaret","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What outcome problem does the study focus on for face/scalp CSCC?","Question",{"text":112,"@type":113},"It focuses on the poor prognosis when patients develop delayed regional metastasis from scalp/facial CSCC rather than the generally favorable outcome seen in most cases.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was the study conducted and what time window was analyzed?",{"text":117,"@type":113},"It retrospectively analyzed records of patients whose regional metastasis occurred at least 6 months after the primary CSCC diagnosis, treated at a tertiary academic head and neck clinic between 2012 and 2018.",{"name":119,"@type":110,"acceptedAnswer":120},"Which factor predicted delayed regional cervical lymph node recurrence?",{"text":121,"@type":113},"Perineural invasion in the primary tumor was the only observed predictor of delayed neck lymph node recurrence.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},371408,1790471954,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},137451207643,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Archives of Dermatological Research (2025) 317:703  \n[https://doi.org/10.1007/s00403-025-04224-9](https://doi.org/10.1007/s00403-025-04224-9)  \nORIGINAL PAPER  \nDelayed regional metastasis from small face/scalp cutaneoussquamous carcinoma: outcomes and predictors  \nCourtney B. Shires1 · John D. Boughter2 · Christopher P. Golembeski3 · Nicholas M. Sharp4 · Arabella T. Hall5 · Merry E. Sebelik6  \nReceived: 10 January 2025 / Revised: 27 March 2025 / Accepted: 2 April 2025 © The Author(s) 2025  \nAbstract  \nObjective: CSCC (cutaneous squamous cell carcinoma) of the face/scalp generally has a favorable outcome. However, patients with delayed regional metastasis from scalp/facial CSCC do very poorly. Historically, prophylactic treatment of the N0 neck for the T1-T2 (as staged in the AJCC 7th edition) face/scalp cancers has not been recommended. This study aims to determine predictors of delayed regional metastases in \u003C 4 cm CSCC of the face and scalp. Methods: We retrospectively analyzed medical records of patients diagnosed regional metastasis of CSCC of the scalp/face at least 6 months after the diagnosis of the primary CSCC at a tertiary academic head and neck clinic during a period between 2012 and 2018. Results: A total of 50 patients with CSCC of the face/scalp were diagnosed and treated for delayed cervical lymph node metastasis during a 6-year period. All patients were male. Areas affected were the scalp, cheeks, and forehead. No patient had neck lymph node metastases at initial presentation for their scalp/face cancer. The presence of perineural invasion in the primary tumor was the only observed predictor of delayed neck lymph node recurrence. We did not observe an association between diameter/depth of the primary skin tumor or lymphovascular invasion and the presence of regional lymph node recurrence. Conclusion: In our review, perineural invasion (PNI) was the one factor predictive of delayed regional lymph node metastasis. This observation confirms the use of PNI to upstage even small CSCC to T3 . Prophylactic treatment of the neck in patients with small scalp/face cancers with PNI should be strongly considered, especially in the age of immunotherapy.  \nKeywords Skin cancer · Head and neck · Squamous cell carcinoma · Cervical metastasis · Delayed metastasis · Immunotherapy · Scalp · Face · Prognosis · Perineural invasion  \nAbbreviations  \nPresented at: American Academy of Otolaryngology-Head and Neck Surgery Foundation, 2019 Annual Meeting & OTO Experience in New Orleans, Louisiana, September 15–18, 2019.  \n􀀍 Courtney B. Shires[cshires1@gmail.com](cshires1@gmail.com)  \n1 West Cancer Center, Germantown, TN, USA  \n2 Department of Neuroanatomy, University of Tennessee, Memphis, TN, USA  \n3 Baptist Memorial Hospital and PathGroup, Memphis, TN, USA  \n4 Baptist University College of Osteopathic Medicine, Memphis, TN, USA  \n5 Samford University, Homewood, AL, USA  \n6 Department of Otolaryngology, Emory University, Atlanta, GA, USA  \nCSCC  \nPNI  \nAJCC  \nHNCSCC  \nBWH  \nLVI  \nECE  \nEAC  \nICIs  \nCTLA-4  \nPD-1  \nPD-L1  \nFDA  \nNCT  \nHPV  \nCutaneous squamous cell carcinoma Perineural invasion  \nAmerican Joint Committee on Cancer Head and neck cutaneous squamous cell carcinoma  \nBrigham and Women’s Hospital Lymphovascular invasion Extracapsular extension  \nExternal auditory canal  \nImmune checkpoint inhibitors Cytotoxic T-lymphocyte antigen-4 Programmed cell death-1  \nProgrammed cell death ligand-1  \nFood and Drug Administration National Clinical Trial Human papillomavirus  \n1 3  \nCAP College of American Pathologists  \nIntroduction  \nCutaneous SCC (CSCC) occurs in 15–35 patients per 100,000 population, and most have an excellent prognosis with surgical excision [1] . T1-T2 tumors as staged in the American Joint Committee on Cancer (AJCC) 7th edition did not clearly correlate with poor outcomes. A major limitation to AJCC 7 was that the bulk of local recurrence, nodal metastasis, or death from CSS occurred in AJCC 7 stageT2 because high","cbCaioTyJR7ekEGi","https://ap.wps.com/l/cbCaioTyJR7ekEGi","pdf",1718498,13,"English","# Abstract\n## Objective\n## Methods\n## Results\n## Conclusion\n# Introduction\n## CSCC incidence and outcomes\n## AJCC 7 vs AJCC 8 upstaging\n## Head and neck relevance\n## Definitions and T3 criteria","[{\"question\":\"What outcome problem does the study focus on for face/scalp CSCC?\",\"answer\":\"It focuses on the poor prognosis when patients develop delayed regional metastasis from scalp/facial CSCC rather than the generally favorable outcome seen in most cases.\"},{\"question\":\"How was the study conducted and what time window was analyzed?\",\"answer\":\"It retrospectively analyzed records of patients whose regional metastasis occurred at least 6 months after the primary CSCC diagnosis, treated at a tertiary academic head and neck clinic between 2012 and 2018.\"},{\"question\":\"Which factor predicted delayed regional cervical lymph node recurrence?\",\"answer\":\"Perineural invasion in the primary tumor was the only observed predictor of delayed neck lymph node recurrence.\"}]","Delayed regional metastasis from small face/scalp cutaneous squamous carcinoma - outcomes and predictors | PDF",1790192005,33]