Study design: Retrospective analysis of a large population database.
Explore this issue:June 2012
Setting: College of Medicine, Hollings Cancer Center, the Department of Surgery-Division of Surgical Oncology, and Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston.
Synopsis: The authors identified 2,104 HN-MCC patients and 2,272 NHN-MCC patients using the SEER database. Disease-specific survival was similar between the groups. In comparing differences in clinicopathologic characteristics between the groups, the team identified independent prognostic factors in HN-MCC such as male gender, lip primary site, tumor extension beyond the dermis, histologically confirmed nodal disease, absence of histologic lymph node evaluation and distant metastasis. Male gender and tumor extension limited to the subcutis are factors for poor prognosis that are unique to HN-MCC. In contrast to the current American Joint Committee on Cancer staging system, this study reports that increasing tumor size does not appear to predict survival for patients with HN-MCC; therefore, staging tumors according to size may not be accurate. Patients with tumors on the lip were noted to have the poorest survival. The authors also demonstrated that the five-year survival rate was worse for patients only evaluated clinically compared with those who received pathologically confirmed negative nodal disease. Differences between HN-MCC and NHN-MCC were found with regard to lymph node metastasis. A limitation of the study was that analysis was limited to data collected by the Surveillance, Epidemiology and End Results (SEER) registries.
Bottom line: Factors that predict poorer disease-specific survival for patients with HN-MCC include male gender, lip primary site, subdermal tumor extension, nodal disease and distant metastasis. In contrast to patients with NHN-MCC, sentinel lymph node status was not predictive of survival for those with HN-MCC. However, the authors recommend routine histopathological analysis of the regional nodes for all MCC patients because of its prognostic significance.
Reference: Smith VA, Camp ER, Lentsch EJ. Merkel cell carcinoma: identification of prognostic factors unique to tumors located in the head and neck based on analysis of SEER data. Laryngoscope. 2012;122(6):1326-1330.
—Reviewed by Sue Pondrom
Nomenclature Paradigm for Benign Midmembranous Vocal Fold Lesions
Is there a validated multidimensional nomenclature paradigm for benign midmembranous vocal fold lesions (BVFL)?
Background: There is a significant lack of uniform agreement regarding nomenclature for BVFLs, with confusion resulting in difficulty for clinicians in communicating with their patients and with each other. Additionally, BVFL research and comparison of treatment methods are hampered by the lack of a detailed and uniform BVFL nomenclature.