Abstract
P 060
The significance of lymph node status in squamous cell carcinoma of the eyelids
Michaela Moelle, Hans Mittelviefhaus
Universitäts-Augenklinik Freiburg
Objective
The significance of perioperativ lymph node diagnostic in squamous cell carcinoma of the eyelids was analysed based on the literature, while developing a guideline for the treatment of these tumors. Since there is a lack of information in the ophthalmological literature regarding lymph node metastases literature of the dermatology, the otorhinolaryngology and the oral and maxillofacial surgery were as well included.
Methods
We performed a selective literature research of publications from 1975 until 2008 in the databases Medline, PubMed, Ovid, Embase and the Cochrane library. Further publications were identified based on the references. The searching terms were the following: squamous cell carcinoma eyelid; Plattenepithelkarzinom, Augenlider; Cancer, Periocular; Staging, Cutaneous Squamous Cell Carcinoma Head; Lymphnode Metastases, Squamous Cell Carcinoma.
Results
The parotideal lymph nodes are not only the first lymph node station of lateral localized eyelidtumors but also of medial localized ones. They are the most frequently affected lymph nodes with 68% of all metastases. The jugulodigastric lymph nodes (level II) and the submandibular lymph nodes (Level I) represent second order lymph nodes with 45.5 % and 9 % of the regional metastases. In case of parotideal metastases up to 26% of patients will have clinically evident and 20-42% occult cervical metastases as well. Without regional metastases 5-year survival in cutaneous squamous cell carcinoma of the head is 75-90%. Survival rate decreases to 25-46 % in case of regional metastases (median survival-time: 11.7-49 months). Simultaneous parotideal and cervical metastases worsen the prognosis significantly. The majority of regional metastases occur within the first two years after tumorexcision. Intervals of up to five years are reported in single cases. Up to 6.2% of the patients with regional lymph node metastases develop especially pulmonal distant metastases.
Conclusions
The parotideal and cervical lymph nodes should be examined sonographically already preoperatively. Postoperatively quarterly follow-up exams, and after 2 years yearly exams are indicated. High-risk patients should be examined longer than five years. However, staging for distance metastases is only warranted in case of evident regional parotideal or cervical metastases.
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