- Joined
- Dec 18, 2015
- Messages
- 3,216
- Reaction score
- 4,930
This is a case that checks disparate boxes and is rare. Thus it makes it a little confusing.
59yo male in excellent health. Non smoker. No drug use. Perhaps 40yo ago had some sort of injury and broke nose and cartilage was exposed or something like that. Never quite healed for a while, in vestibular region. About 6 mos ago had a right neck node suddenly appear. Asymptomatic. Had a simple but complete excisional biopsy of that by community ENT. Was SCC p16+. N1, level 2, maybe 3. No adverse features. Very negative margins. Extensive hunt for primary undertaken including bilateral tonsillectomy, endoscopy. PET negative. Exams negative. No primary ever found.
I saw him at that point. Essentially T0N1 unk primary. I recommended observation. Academic center recommended completion dissection and XRT to necks and oropharynx in standard unk primary style; I even think chemoRT was recommended.
He went with observation.
Following w ENT he soon had a “sore” in nasal vestibule on right come up. Treated for staph for about 2 mos. Began growing. Was biopsied. Is a p16+ SCC of nasal vestibule. I’d put its size on palpation at 2cm and I feel a little fixation. It’s non painful and not bleeding. All other exams negative. Neck well healed. I don’t have any imaging yet.
I have a clear idea about what I want to do: chemoRT w cis basically, necks to 45-50 and primary to 70. But I am wishing to know what others might do. I also like “connecting volumes” and getting the nasal vestibule to connect up with neck contours seems like I might be treating some face. Also think level 1 is in order.
59yo male in excellent health. Non smoker. No drug use. Perhaps 40yo ago had some sort of injury and broke nose and cartilage was exposed or something like that. Never quite healed for a while, in vestibular region. About 6 mos ago had a right neck node suddenly appear. Asymptomatic. Had a simple but complete excisional biopsy of that by community ENT. Was SCC p16+. N1, level 2, maybe 3. No adverse features. Very negative margins. Extensive hunt for primary undertaken including bilateral tonsillectomy, endoscopy. PET negative. Exams negative. No primary ever found.
I saw him at that point. Essentially T0N1 unk primary. I recommended observation. Academic center recommended completion dissection and XRT to necks and oropharynx in standard unk primary style; I even think chemoRT was recommended.
He went with observation.
Following w ENT he soon had a “sore” in nasal vestibule on right come up. Treated for staph for about 2 mos. Began growing. Was biopsied. Is a p16+ SCC of nasal vestibule. I’d put its size on palpation at 2cm and I feel a little fixation. It’s non painful and not bleeding. All other exams negative. Neck well healed. I don’t have any imaging yet.
I have a clear idea about what I want to do: chemoRT w cis basically, necks to 45-50 and primary to 70. But I am wishing to know what others might do. I also like “connecting volumes” and getting the nasal vestibule to connect up with neck contours seems like I might be treating some face. Also think level 1 is in order.