Neck dissection in pT1 maxillary squamous cell carcinoma: Necessity or overtreatment?

PURPOSE: Squamous cell carcinoma (SCC) is the most common malignancy of the oral cavity. Despite cN0 staging, elective neck dissection (END) is often performed to detect occult cervical lymph node metastases (cLNM). Maxillary SCC (MSCC) generally exhibits similar metastases rates to intraoral SCC in other locations. However, due to the rarity of T1 MSCC, the current guidelines of the German Society for Oral and Maxillofacial Surgery do not provide a clear recommendation for neck dissection (ND) in these cases, as existing data are limited.

METHODS

A retrospective analysis was conducted on all cases with SCC of the superior level of the oral cavity diagnosed at Hannover Medical School over the past 20 years (n = 225). cLNM in pT1 cases (n = 36) were specifically examined.

RESULTS

In pT1 MSCC cases confined to the alveolar process and hard palate, cLNM was detected in only one patient (1/25, 4.00%). In contrast, a significantly higher occurrence of cLNM was observed in pT1 SCC of the soft palate (4/11, 36.36%, p [Fisher] = 0.023).

CONCLUSION

In accordance with current guidelines, ND may not be necessary for pT1 MSCC. However, if SCC infiltrates the soft palate, ND should be considered. Given the rarity of pT1 MSCC, further studies with larger datasets are needed to establish definitive recommendations.