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Woods et al. J Cancer Metastasis Treat 2022;8:22 https://dx.doi.org/10.20517/2394-4722.2022.28 Page 9 of 14

[133]
promise . For adnexal malignancies, chemotherapy may be beneficial in patients with metastatic disease,
while anti-estrogenic treatment and human epidermal growth factor receptor 2 inhibitors have been used in
[124]
some cases with variable outcomes .

CONCLUSION
Cutaneous malignancy of the head and neck can spread to the superficial and/or deep lymphatic network,
including pre- and post-auricular nodes, parotid nodes, suboccipital nodes, and deep jugular chain nodes,
depending on the location and features of the primary tumor. Patient factors such as immunocompromise
need to be considered. Clinical evaluation of the parotid and neck should be performed in all patients with
head and neck NMSC. Pre-operative imaging is also recommended.

Treatment for lymphatic spread of cutaneous malignancy of the head and neck typically involves surgical
resection with adjuvant radiation. Appropriate management of anatomical structures in the head and neck
is important to ensure the best surgical outcomes. New systemic therapies, such as cemiplimab, are
demonstrating promising results in clinical trials. Management in a multidisciplinary setting is
recommended.

DECLARATIONS
Authors’ contributions
Made substantial contributions to conception and design of the study and performed data interpretation
and manuscript drafting: Woods RSR, Woods JFC, Fitzgerald CWR, Alameer E, Lopez J, Singh B, Shah JP
Supervised the writing process: Singh B, Shah JP
Approved the final version of the report: Woods RSR, Woods JFC, Fitzgerald CWR, Alameer E, Lopez J,
Singh B, Shah JP

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflict of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2022.

REFERENCES
1. Shah JP. Jatin shah’s head and neck surgery and oncology. 5th ed. St. Louis, MO: Elsevier Inc.; 2019.
2. Vauterin TJ, Veness MJ, Morgan GJ, Poulsen MG, O’Brien CJ. Patterns of lymph node spread of cutaneous squamous cell carcinoma
of the head and neck. Head Neck 2006;28:785-91. DOI PubMed
3. Marks NJ. The anatomy of the lymph nodes of the parotid gland. Clin Otolaryngol Allied Sci 1984;9:271-5. DOI PubMed