Should the contralateral tonsil be removed in cases of HPV-positive squamous cell carcinoma (SCC) of the tonsil?
Maie St. John, MD, PhD, chair of head and neck surgery at the University of California, Los Angeles, said that, based on literature review, in cases of HPV-positive SCC of one of the tonsils, it’s unknown just how often there’s also a tumor on the other tonsil. Routinely removing the contralateral tonsil brings concerns of pain, increased bleeding risk, or scarring. Missing occult disease in the contralateral tonsil, however, could be fatal.
Explore This IssueMarch 2021
The published evidence, Dr. St. John said, recommends that the contralateral tonsil should be removed routinely in cases of HPV-positive tonsillar SCC, since it doesn’t appear to increase rates of morbidity or complications, and identifying contralateral disease can “dramatically alter treatment and prognosis.”
In one retrospective review of 211 cases, seven of the patients (3.3%) had synchronous bilateral tonsillar HPV-positive SCC (SBTC), and another two patients had moderate to severe dysplasia on the contralateral tonsil, with no preoperative clinical or radiographic evidence of contralateral disease (Clin Otolaryngol. 2018;43:1-6).
Future studies, said Dr. St. John, should make attempts to identify “clinical disparities or differences” in tumor traits that could improve preoperative identification of patients with SBTC.
Thomas R. Collins is a freelance medical writer based in Florida.