Cutaneous squamous cell carcinoma of the head and neck: the road to a tailored approach

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    The incidence of cutaneous squamous cell carcinoma of the head and neck (cSCCHN) is rising, especially in the elderly population. In this thesis we assessed different aspects of diagnosis and treatment of cSCCHN. We found that a staging system using the cumulative number of risk factors is more accurate for predicting poor outcome. Age was not found to be an independent risk factor for disease progression, but risk factors were age-specific. We observed more deviation from the treatment guideline in frail patients, and a small impact of diagnosis and treatment of cSCCHN on quality of life. Most regular treatment options can also be used with good results in the elderly population. However, a watchful waiting policy can be considered instead of extensive treatment, depending on the expected morbidity and patient preferences. Results on lymph node metastasis showed that only tumor location was associated with the pattern of metastasis. Therefore, tumor location could be used to limit the extent of the neck dissection, especially in elderly or frail patients. In the case of incomplete excision of cSCCHN, re-excision is the gold standard treatment. Postoperative radiotherapy is a good treatment option if re-excision is not preferable. Systemic treatment with programmed death receptor 1 (PD-1) inhibitors has been approved for patients with advanced cSCCHN. If eligibility criteria of the registration study are applied, only 43.5% of patients with advanced cSCCHN in our cohort would be eligible. However, if only absolute exclusion criteria (based on literature and clinical experience) are applied, 94.2% would be eligible for treatment with PD-1 inhibitors.
    Originele taal-2English
    KwalificatieDoctor of Philosophy
    Toekennende instantie
    • Rijksuniversiteit Groningen
    Begeleider(s)/adviseur
    • Horvath, Barbara, Supervisor
    • Rácz, Emöke, Co-supervisor
    • Plaat, Boudewijn, Co-supervisor
    Datum van toekenning18-mei-2022
    Plaats van publicatie[Groningen]
    Uitgever
    DOI's
    StatusPublished - 2022

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