Depth of Invasion in Tongue and Floor of the Mouth Squamous Cell Carcinoma

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • The most important histologic feature of the primary tumor:
    • That affects selection of treatment and eventual prognosis:
      • Is its depth of invasion (DOI)
  • Thin and superficially invasive lesions:
    • Have a lower risk of regional lymph node metastasis
    • Are highly curable
    • Offer an excellent prognosis
  • Thicker lesions that deeply infiltrate the underlying soft tissues:
    • Have a significantly increased incidence of regional lymph node metastasis and an adverse impact on prognosis
  • The risk of lymph node metastasis and survival rates in relation to the DOI of the primary lesion for T1 and T2 squamous carcinomas of the oral tongue and floor of mouth are shown in Figure:
    • Although it would be ideal to know the exact DOI of the lesion before surgical intervention, having that information before surgical excision and histopathologic examination of the primary tumor is not possible
  • In general, however, estimate of DOI by assessing thickness of the lesion as appreciated by palpation:
    • Is a reasonably good indicator of deeply invasive lesions versus superficial lesions:
      • To estimate the extent of soft tissue and / or bone resection for the primary lesion and to decide on the need for elective dissection of the regional lymph nodes at risk in a clinically negative neck
Primary tumors of the oral cavity are categorized as thin, thick, and very thick by palpation
  • Several retrospective studies have identified DOI of the primary tumor:
    • As an important determinant of prognosis:
      • Thus DOI is now included in T staging of primary tumors of the oral cavity
The incidence of occult nodal metastasis in the clinically negative neck for patients and disease-specific survival for patients with T1 and T2 oral carcinoma in relation to depth of invasion (DOI).
(Memorial Sloan Kettering Cancer Center data, 1985 to 2015).
#Arrangoiz #CancerSurgeon #HeadandNeckSurgeon #HeadandNeckOncology #ThyroidSurgeon #ParathyroidSurgeon #SurgicalOncologist #Miami #Mexico #MountSinaiMedicalCenter #MSMC

Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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