Lymphadenectomy for anterior cutaneous malignancies of the head and neck

Cutaneous cancer is the most common malignancy in the United States. Basal cell carcinomas (BCC), squamous cell carcinomas (SCC) and Merkel cell carcinoma (MCC) represent the nonmelanoma category and correspond to 3.5 million skin cancers annually. Melanoma, a more aggressive skin cancer with a higher propensity for regional metastases, represents 5% of all diagnosed skin cancers, but 75% of skin cancer related deaths. Appropriate evaluation and management of regional lymph nodes is an important part of workup, staging and prognosis. Cervical lymphadenectomy in anterior cutaneous malignancies is dependent on the histology of lesion, location of the primary lesion, stage at presentation, and the status of the parotid basin. Regardless of histology, node positive disease in the absence of distant metastasis should be managed surgically with complete lymphadenectomy. In anterior cutaneous malignancies, this includes level I-IV neck dissection and often a parotidectomy. As for the N0 neck, appropriate evaluation and management of at-risk nodal basins differs by the type of cancer. In this article, we will review workup and management of head and neck primary skin cancers, and present our technique for anterior cervical lymphadenectomy.