Clinical and Histopathological Predictors of Survival in Regional Lymph Node Metastases From Cutaneous Squamous Cell Carcinoma of the Head and Neck: A Retrospective Analysis

BACKGROUND: Cutaneous squamous cell carcinoma (cSCC) is a common skin cancer, with a subset demonstrating aggressive behaviour leading to regional lymph node metastases and poor prognosis. This study evaluated the clinical characteristics, prognostic factors, and survival outcomes in patients with nodal metastases from head and neck cSCC. METHODS: A retrospective analysis was performed on 19 patients with histologically confirmed nodal metastases from cSCC treated between 2018 and 2023 at East Kent Hospitals NHS Trust. Data on patient demographics, tumour features, treatment, and follow-up were reviewed. Survival outcomes were estimated using Kaplan-Meier analysis, and univariate Cox regression identified potential prognostic factors for disease-free survival (DFS) and overall survival (OS). RESULTS: The mean patient age was 84.3 years, with a male predominance (84.2%). Primary tumours were most frequently located on the scalp and cheek and were predominantly moderately or poorly differentiated. High-risk features included tumour size >2 cm, perineural invasion (36.8%), and extracapsular extension (52.6%). All patients underwent neck dissection, with 47% requiring additional parotidectomy; 94.7% received adjuvant radiotherapy. Despite this, the majority developed recurrence within 11 months. The five-year OS was 21.1%, and DFS was 5.3%. Tumour size was significantly associated with reduced DFS (p=0.026), while other pathological variables showed no independent effect. CONCLUSIONS: Metastatic cSCC of the head and neck carries a poor prognosis, even with aggressive multimodal therapy. High-risk pathological features remain key predictors of recurrence. Improved risk stratification and incorporation of novel systemic therapies may help improve long-term outcomes in this patient group.