Clinical evaluation of patients with metastatic squamous carcinoma of the neck with occult primary tumor.

Between 1976 and 1982, we systematically evaluated 33 patients with a diagnosis of metastatic squamous carcinoma of the neck (excluding the supraclavicular fossa) from an occult primary tumor. In 11 patients the primary lesion was identified by physical and indirect mirror examinations, in four by examinations done under anesthesia and panendoscopies, and in an additional three by random biopsies. Primary lesions were in the nasopharynx (five patients), hypopharynx (five), tonsillar fossa (three), epiglottis (two), lateral oropharyngeal wall (one), the base of the tongue (one), and the anterior tonsillar pillar (one). In 15 patients (45%), the primary lesion was not identified after complete evaluation; these patients remained free of primary lesions in the head and neck area during a follow-up of two to six years. Our results indicate that patients with metastatic carcinoma of the neck should have a complete evaluation before treatment is started; in the majority of these patients, the primary site can be identified, with a resultant change in the treatment plan. A review of the literature shows that metastatic squamous carcinoma of the neck with an unknown primary tumor is a treatable disease with a cure rate as high as 50%.