Management of the neck in metastatic cutaneous squamous cell carcinoma of the head and neck

Purpose of review: This article reviews the predictors, prognosis, and treatment of nodal metastases in cutaneous squamous cell carcinoma of the head and neck. Recent findings: There is a better understanding of the risk factors that predict metastatic disease in cutaneous squamous cell carcinoma. Recent data has simplified the relationship between the site of the primary tumour and nodal disease, allowing for a more selective approach to the neck, in terms of both surgery and radiotherapy. Newer staging systems that take into account the clinicopathological factors allow better prognostication, and their application has been discussed. There is ongoing research on concurrent chemoradiotherapy, sentinel node biopsy, and epidermal growth factor receptor overexpression. Summary: The status of the parotid and level II/III nodes has important implications for the management of the neck, and therefore dissection of level I and level IV/V nodes is required in selected cases only. Prognostic stratification is needed to tailor treatment algorithms that intensify therapy in high-risk disease and minimize toxicity in selected low-risk patients.