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specimens with less than 1 cm of non-affected tissue response around the primary tumour could allow
around the tumor. Illustratively, only 4% of patients in easier dissemination of cancer cells through lymphatic
the first group developed CLNM in contrast to 11.6% of drainage. [20]
patients in the last group. Nason et al. found that
[12]
[32]
each 1-mm increase in clear surgical margin decreased Local-regional recurrence
the risk of death at 5 years by 8%. Other authors have Local recurrence has been defined as an independent risk
also demonstrated that surgical margins had a statistical factor for CLNM in the study of Liao et al. Specifically,
[31]
association with a higher risk of CLNM developing. [7] the percentage of CLNM was 18% (17/132) in patients
with LR, and 5% (38/781) in those without.
Grade of histological differentiation
Histopathological grading is also an important predictive TREATMENT OPTIONS
factor for the occurrence of CLNM in head and neck SCC.
[5]
For Kurita et al. the risk for CLNM increased as the The possibility of occult CLNM in the OSCC requires a
degree of histopathological grading advanced. In another challenging decision: whether the contralateral neck
study, González-García et al. also demonstrated a should be electively treated or not. No consensus
[12]
statistically significant association between histological has been reached on the need for contralateral neck
grading and the appearance of CLNM and found that dissection (CND) or radiotherapy. Implications of such
13.5% of the patients with poor-differentiated SCC treatment on the contralateral side include the advantage
developed CLNM, in comparison with 5.2% of patients of treating subclinical disease on the one hand, but on the
with well-differentiated tumors. Other authors also have other hand, because these cases have a poor prognosis,
identified poor tumour differentiation as a significant treatment may lead to a significant increase in morbidity
predictor. [5,20,31,33] and even mortality without improvement.

Tumor satellite distance Neck dissection
Tumor satellites can be defined as separate islands of Appropriate management of cervical lymph nodes is an
tumor cells at the tumor and nontumor interface. Tumor important aspect of the treatment of patients with OSCC.
satellite distance (TSD) is the distance from the main Although elective treatment of the contralateral neck is
tumor to the most distant tumor satellite and reflects accepted for oral cancers approaching or crossing the
the spreading ability of tumor satellites. In the literature, midline, this is not routinely performed in lateralized
microsatellite tumor spreading was reported to reach cases. Unfortunately, even with the use of elective CND
as far as 1.8 cm. Yang et al. reported that TSD is for ipsilateral tumors crossing the midline, approximately
[34]
[35]
significantly associated with the survival of patients with one-third of neck lymph node recurrences occur at the
tongue cancer in areas of endemic betel nut consumption. contralateral site. So, it is unclear whether the use of
In addition, increased TSD is associated with a higher elective CND may reduce incidence of contralateral neck
incidence of local recurrence, shorter intervals to neck recurrences in this patient group.
recurrence, and a higher tendency to contralateral or
bilateral neck metastasis. Various studies have failed to show a benefit in the
survival rate from elective treatment of the contralateral
Perineural and lymphovascular invasion neck. [11,13,36] The reduced survival in some patients with
Perineural infiltration of the primary tumor has been shown OSCC appears to reflect aggressive disease biology with
to be highly predictive for CLNM, as it was illustrated in regional and/or distant failure in spite of salvage therapy,
the series of González-García et al. by the appearance suggesting that elective treatment of the contralateral
[12]
of pathologic contralateral lymph neck nodes in 17.02% of neck is unlikely to improve their prognosis. So, some
patients with perineural infiltration, in comparison with surgeons advocate an observation-only policy for the
4.1% of those patients without perineural involvement. In contralateral neck. For example, Lim et al. examined
[11]
[7]
the study of Capote-Moreno et al., perineural invasion 54 patients with early stage SCC of the oral tongue.
also turned out to be arelevant factor for contralateral The goal of this study was to determine if there was an
metastases. Kowalski et al. suggested the presence of outcome difference between patients who underwent
[6]
lymphovascular involvement, as well as of perineural observation of the contralateral neck (29 patients) versus
infiltration, were significantly associated to higher rates of the 25 patients who underwent bilateral elective neck
risk of CLNM in OSCC. dissection (END). Notably, 7 patients in the ‘‘observation’’
group underwent radiation therapy that included the
Peritumoral inflammation contralateral neck. The incidence of recurrence at any
A statistically significant association between the site in this study was 17/54 (31%), with no recurrences in
absence of peritumoral inflammation and the appearance the contralateral neck. There was only 1 of 25 (4%) CNDs
of CLNM has been observed. A possible explanation for that showed occult malignancy. There was no significant
this association could be that a low host immunological difference in the disease-free survival between those
Plast Aesthet Res || Volume 3 || June 24, 2016 185