How do you decide whether or not to cover elective lymphatics when treating cutaneous squamous cell carcinoma of the head and neck with definitive RT?

I dont think there's a good, single, validated tool for determining when nodes should be selectively treated in cutaneous SCC. Various sources suggest risk factors for nodal disease - size > 2 cm, depth > 4mm, poorly differentiated tumors, PNI, LVSI, immunosuppression, recurrent disease, and body site (HN worse than trunk, and it seems that tumors near the parotid/pre-auricular region may be higher risk). But these are more useful when none are present in knowing that nodal irradiation can be av...

Cutaneous squamous cell carcinoma of the scalp spreads to the head and neck lymphatics more frequently than most physicians realize. The decision as to whether or not to prophylactically treat the lymphatics depends upon the location of the tumor, the size of the lesion, and its degree of differentiation.

Lesions located near the vertex can go in almost any direction making prophylactic node treatment quite difficult to predict. As the lesions appear further down on the scalp, especially in the ...