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Article

Metastatic Head and Neck Non-Melanoma Skin Cancer: A Retrospective Analysis of Clinico-Pathologic Features and Reconstructive Approach

by
Victor Vlad Costan
1,
Otilia Boișteanu
2,
Delia Gabriela Ciobanu Apostol
3,
Ștefan Vasile Toader
4,
Cristina Colac Boțoc
5,*,
Alin Gabriel Colac
1,
Mihai-Liviu Ciofu
1 and
Mihaela Paula Toader
6
1
Department of Oral and Maxillofacial Surgery, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
2
Department of Anesthesiology and Intensive Care, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
3
Department of Morpho-Functional Sciences I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
4
Discipline of Physiopathology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
5
Dermatology Clinic, University Clinical Railways Hospital, 700115 Iasi, Romania
6
Discipline of Oral Medicine, Oral Dermatology (Dermato-Venereology), Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(18), 6650; https://doi.org/10.3390/jcm14186650
Submission received: 5 August 2025 / Revised: 9 September 2025 / Accepted: 17 September 2025 / Published: 21 September 2025
(This article belongs to the Special Issue Clinical Advances in Skin Cancer: A Closer Look at Non-Melanoma Types)
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Abstract

Background/Objectives: Non-melanoma skin cancer (NMSC) is the most common malignancy globally, with cutaneous squamous cell carcinoma (cSCC) posing a significant risk of regional metastasis, especially in high-risk anatomical areas such as the head and neck. While general risk factors for metastasis are well known, few studies have directly compared the clinical and pathological features of synchronous versus metachronous metastatic behavior. This study aimed to evaluate the clinicopathological characteristics and reconstructive implications associated with these two metastatic patterns in head and neck NMSC. Methods: We conducted a retrospective observational study of 46 patients with histologically confirmed metastatic NMSC of the head and neck, treated between January 2022 and May 2024 at a tertiary care center. Patients were stratified into synchronous or metachronous metastasis groups. Clinical data, histopathological features, metastatic sites, and surgical approaches were analyzed. Comparative statistics were applied using chi-square and t-tests, with significance set at p < 0.05. Results: Of the 46 patients, 50% had synchronous and 50% had metachronous metastases. The lower lip was the most common primary tumor site in both groups. Perineural and lymphovascular invasion were more frequent in synchronous metastases. Metachronous cases often required more complex reconstructive procedures, including free flap reconstructions and mandibular resections. Patients with metachronous metastases were significantly older (p = 0.024), and approximately one-third developed metastases more than four years after initial treatment. Conclusions: Head and neck NMSC, particularly involving the lower lip, may exhibit late-onset metastatic potential. Risk-adapted surveillance extending beyond current guidelines is warranted to improve long-term outcomes in high-risk patients.
Keywords: NMSC; cSCC; head and neck metastases; reconstructive surgery NMSC; cSCC; head and neck metastases; reconstructive surgery

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MDPI and ACS Style

Costan, V.V.; Boișteanu, O.; Ciobanu Apostol, D.G.; Toader, Ș.V.; Colac Boțoc, C.; Colac, A.G.; Ciofu, M.-L.; Toader, M.P. Metastatic Head and Neck Non-Melanoma Skin Cancer: A Retrospective Analysis of Clinico-Pathologic Features and Reconstructive Approach. J. Clin. Med. 2025, 14, 6650. https://doi.org/10.3390/jcm14186650

AMA Style

Costan VV, Boișteanu O, Ciobanu Apostol DG, Toader ȘV, Colac Boțoc C, Colac AG, Ciofu M-L, Toader MP. Metastatic Head and Neck Non-Melanoma Skin Cancer: A Retrospective Analysis of Clinico-Pathologic Features and Reconstructive Approach. Journal of Clinical Medicine. 2025; 14(18):6650. https://doi.org/10.3390/jcm14186650

Chicago/Turabian Style

Costan, Victor Vlad, Otilia Boișteanu, Delia Gabriela Ciobanu Apostol, Ștefan Vasile Toader, Cristina Colac Boțoc, Alin Gabriel Colac, Mihai-Liviu Ciofu, and Mihaela Paula Toader. 2025. "Metastatic Head and Neck Non-Melanoma Skin Cancer: A Retrospective Analysis of Clinico-Pathologic Features and Reconstructive Approach" Journal of Clinical Medicine 14, no. 18: 6650. https://doi.org/10.3390/jcm14186650

APA Style

Costan, V. V., Boișteanu, O., Ciobanu Apostol, D. G., Toader, Ș. V., Colac Boțoc, C., Colac, A. G., Ciofu, M.-L., & Toader, M. P. (2025). Metastatic Head and Neck Non-Melanoma Skin Cancer: A Retrospective Analysis of Clinico-Pathologic Features and Reconstructive Approach. Journal of Clinical Medicine, 14(18), 6650. https://doi.org/10.3390/jcm14186650

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