Lymph node metastases from auricular squamous cell carcinoma. A systematic review and meta-analysis

SummaryIntroductionSquamous cell carcinoma arising on the auricle is believed to metastasise to the regional lymph nodes more frequently than comparable tumours at other sites. Metastatic spread of these tumours is associated with a poor outcome but there is no clear consensus of opinion on how to identify patients at risk of metastatic spread and treat them.Materials and methodsA systematic review database search of Medline and Embase was conducted with cross referencing of articles.ResultsThe metastatic rate is 11.2% with spread to the parotid and upper deep cervical chain most common. Eighty-five per cent of metastases develop within 12 months and 98% within 24 months, although follow up was limited to 12 to 36 months in most cases. Death occurs in 6.2% of cases (about half of the patients who develop metastases) usually due to failure of loco-regional control. Depth of invasion, tumour size, degree of cellular differentiation and incomplete primary excision margins may be useful in identifying lesions most at risk of metastasising but there is insufficient evidence at present to allow targeted neck dissections.