Skip to main content

Considerations for Nonmelanoma Skin Cancer: Clinical Presentation

  • Chapter
  • First Online:
Malignancies of the Groin

Abstract

Lymphadenopathy of the groin, or inguinal lymphadenopathy, may be a feature of a number of systemic diseases, both benign and malignant. Benign causes of inguinal lymphadenopathy include infection, as well as vascular and autoimmune disease. Malignant groin lymphadenopathy may derive from primary skin tumors (melanoma, squamous cell carcinoma, and Merkel cell carcinoma being the most common) of the lower extremity or lower trunk, perineum, reproductive tracts, and lower gastrointestinal tract and leukemias and lymphomas [1]. This chapter focuses on inguinal lymph node metastasis from non-melanoma cutaneous malignancies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Zaren HA, Copeland EM III. Inguinal node metastases. Cancer. 1978;41:919–23.

    Article  CAS  PubMed  Google Scholar 

  2. Prieto-Granada C, Rodriguez-Waitkus P. Cutaneous squamous cell carcinoma and related entities: epidemiology, clinical and histological features, and basic science overview. Curr Probl Cancer. 2015;39:206–15.

    Article  PubMed  Google Scholar 

  3. Alam M, Ratner D. Cutaneous squamous-cell carcinoma. N Engl J Med. 2001;344:975–83.

    Article  CAS  PubMed  Google Scholar 

  4. Parikh SA, Patel VA, Ratner D. Advances in the management of cutaneous squamous cell carcinoma. F1000Prime Rep. 2014;(6):70.

    Google Scholar 

  5. Mullen JT, Feng L, Xing Y, et al. Invasive squamous cell carcinoma of the skin: defining a high-risk group. Ann Surg Oncol. 2006;13:902–9.

    Article  PubMed  Google Scholar 

  6. Rowe DE, Carroll RJ, Day CL Jr. Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip. Implications for treatment modality selection. J Am Acad Dermatol. 1992;26:976–90.

    Article  CAS  PubMed  Google Scholar 

  7. Farasat S, Yu SS, Neel VA, et al. A new American Joint Committee on Cancer staging system for cutaneous squamous cell carcinoma: creation and rationale for inclusion of tumor (T) characteristics. J Am Acad Dermatol. 2011;64:1051–9.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Agelli M, Clegg LX. Epidemiology of primary Merkel cell carcinoma in the United States. J Am Acad Dermatol. 2003;49:832–41.

    Article  PubMed  Google Scholar 

  9. Zhan FQ, Packianathan VS, Zeitouni NC. Merkel cell carcinoma: a review of current advances. J Natl Compr Cancer Netw. 2009;7:333–9.

    Article  Google Scholar 

  10. Eng TY, Boersma MG, Fuller CD, et al. A comprehensive review of the treatment of Merkel cell carcinoma. Am J Clin Oncol. 2007;30:624–36.

    Article  PubMed  Google Scholar 

  11. Clarke CA, Robbins HA, Tatalovich Z, et al. Risk of Merkel cell carcinoma after solid organ transplantation. J Natl Cancer Inst. 2015;107

    Google Scholar 

  12. Locke FL, Rollison DE, Sondak VK. Merkel cell carcinoma and immunosuppression: what we still need to know. J Natl Cancer Inst. 2015;107

    Google Scholar 

  13. Strom T, Carr M, Zager JS, et al. Radiation therapy is associated with improved outcomes in Merkel cell carcinoma. Ann Surg Oncol. 2016;23:3572–8.

    Google Scholar 

  14. Allen PJ, Bowne WB, Jaques DP, Brennan MF, Busam K, Coit DG. Merkel cell carcinoma: prognosis and treatment of patients from a single institution. J Clin Oncol. 2005;23:2300–9.

    Article  PubMed  Google Scholar 

  15. Fields RC, Busam KJ, Chou JF, et al. Five hundred patients with Merkel cell carcinoma evaluated at a single institution. Ann Surg. 2011;254:465–73. discussion 73–5

    Article  PubMed  Google Scholar 

  16. Santamaria-Barria JA, Boland GM, Yeap BY, Nardi V, Dias-Santagata D, Cusack JC Jr. Merkel cell carcinoma: 30-year experience from a single institution. Ann Surg Oncol. 2013;20:1365–73.

    Article  PubMed  Google Scholar 

  17. Carbotta G, Sallustio P, Prestera A, Laforgia R, Lobascio P, Palasciano N. Perineal Paget’s disease: a rare disorder and review of literature. Ann Med Surg (Lond). 2016;9:50–2.

    Article  Google Scholar 

  18. Haydon N, Ting F, Southwell-Keely J. An important differential: extramammary Paget’s disease. Eplasty. 2015;15:ic16.

    PubMed  PubMed Central  Google Scholar 

  19. Cohen JM, Granter SR, Werchniak AE. Risk stratification in extramammary Paget disease. Clin Exp Dermatol. 2015;40:473–8.

    Article  CAS  PubMed  Google Scholar 

  20. Chanda JJ. Extramammary Paget’s disease: prognosis and relationship to internal malignancy. J Am Acad Dermatol. 1985;13:1009–14.

    Article  CAS  PubMed  Google Scholar 

  21. Fu T, Aasi SZ, Hollmig ST. Management of high-risk squamous cell carcinoma of the skin. Curr Treat Options in Oncol. 2016;17:34.

    Article  Google Scholar 

  22. Smith FO, Yue B, Marzban SS, et al. Both tumor depth and diameter are predictive of sentinel lymph node status and survival in Merkel cell carcinoma. Cancer. 2015;121:3252–60.

    Article  PubMed  PubMed Central  Google Scholar 

  23. van der Linden M, Meeuwis K, Bulten J, Bosse T, van Poelgeest M, de Hullu J. Paget disease of the vulva. Crit Rev Oncol Hematol. 2016;101:60–74.

    Article  PubMed  Google Scholar 

  24. Chan JY, Li GK, Chung JH, Chow VL. Extramammary Paget’s disease: 20 years of experience in Chinese population. Int J Surg Oncol. 2012;2012:416418.

    PubMed  PubMed Central  Google Scholar 

  25. O'Connor WJ, Lim KK, Zalla MJ, et al. Comparison of Mohs micrographic surgery and wide excision for extramammary Paget’s disease. Dermatol Surg. 2003;29:723–7.

    Article  PubMed  Google Scholar 

  26. Fujisawa Y, Yoshino K, Kiyohara Y, et al. The role of sentinel lymph node biopsy in the management of invasive extramammary Paget’s disease: multi-center, retrospective study of 151 patients. J Dermatol Sci. 2015;79:38–42.

    Article  PubMed  Google Scholar 

  27. Ogata D, Kiyohara Y, Yoshikawa S, Tsuchida T. Usefulness of sentinel lymph node biopsy for prognostic prediction in extramammary Paget’s disease. Eur J Dermatol. 2016;26:254–9.

    PubMed  Google Scholar 

  28. Sarnaik AA, Puleo CA, Zager JS, Sondak VK. Limiting the morbidity of inguinal lymphadenectomy for metastatic melanoma. Cancer Contr. 2009;16:240–7.

    Article  Google Scholar 

  29. Zhang SH, Sood AK, Sorosky JI, Anderson B, Buller RE. Preservation of the saphenous vein during inguinal lymphadenectomy decreases morbidity in patients with carcinoma of the vulva. Cancer. 2000;89:1520–5.

    Article  CAS  PubMed  Google Scholar 

  30. Dardarian TS, Gray HJ, Morgan MA, Rubin SC, Randall TC. Saphenous vein sparing during inguinal lymphadenectomy to reduce morbidity in patients with vulvar carcinoma. Gynecol Oncol. 2006;101:140–2.

    Article  PubMed  Google Scholar 

  31. Sabel MS, Griffith KA, Arora A, et al. Inguinal node dissection for melanoma in the era of sentinel lymph node biopsy. Surgery. 2007;141:728–35.

    Article  PubMed  Google Scholar 

  32. Abbas S, Seitz M. Systematic review and meta-analysis of the used surgical techniques to reduce leg lymphedema following radical inguinal nodes dissection. Surg Oncol. 2011;20:88–96.

    Article  PubMed  Google Scholar 

  33. Sarnaik AA, Puleo CA, Zager JS, Sondak VK. Limiting the morbidity of inguinal lymphadenectomy for metastatic melanoma. Cancer Control. 2009;16:240–7.

    Article  PubMed  Google Scholar 

  34. Paley PJ, Johnson PR, Adcock LL, et al. The effect of sartorius transposition on wound morbidity following inguinal–femoral lymphadenectomy. Gynecol Oncol. 1997;64:237–41.

    Article  CAS  PubMed  Google Scholar 

  35. Judson PL, Jonson AL, Paley PJ, et al. A prospective, randomized study analyzing sartorius transposition following inguinal-femoral lymphadenectomy. Gynecol Oncol. 2004;95:226–30.

    Article  PubMed  Google Scholar 

  36. Loukas M, El-Sedfy A, Tubbs RS, Wartman C. Jules Germain Cloquet (1790–1883)—drawing master and anatomist. Am Surg. 2007;73:1169–72.

    PubMed  Google Scholar 

  37. Chu CK, Zager JS, Marzban SS, et al. Routine biopsy of Cloquet’s node is of limited value in sentinel node positive melanoma patients. J Surg Oncol. 2010;102:315–20.

    Article  PubMed  Google Scholar 

  38. Illig L, Aigner KR, Biess B, et al. Diagnostic excision of the Rosenmuller’s node. Screening for occult metastases before elective regional lymph node dissection in patients with lower limb melanoma? Cancer. 1988;61:1200–6.

    Article  CAS  PubMed  Google Scholar 

  39. Essner R, Scheri R, Kavanagh M, Torisu-Itakura H, Wanek LA, Morton DL. Surgical management of the groin lymph nodes in melanoma in the era of sentinel lymph node dissection. Arch Surg. 2006;141:877–82. discussion 82–4

    Article  PubMed  Google Scholar 

  40. Coit DG, Brennan MF. Extent of lymph node dissection in melanoma of the trunk or lower extremity. Arch Surg. 1989;124:162–6.

    Article  CAS  PubMed  Google Scholar 

  41. NCCN clinical practice guidelines in oncology: squamous cell skin cancer, version 1, 2016. 2016. NCCN.org. Accessed 19 Sept 2016.

    Google Scholar 

  42. Ross AS, Schmults CD. Sentinel lymph node biopsy in cutaneous squamous cell carcinoma: a systematic review of the English literature. Dermatol Surg. 2006;32:1309–21.

    CAS  PubMed  Google Scholar 

  43. Delman KA, Kooby DA, Rizzo M, Ogan K, Master V. Initial experience with videoscopic inguinal lymphadenectomy. Ann Surg Oncol. 2011;18:977–82.

    Article  PubMed  Google Scholar 

  44. Delman KA, Kooby DA, Ogan K, Hsiao W, Master V. Feasibility of a novel approach to inguinal lymphadenectomy: minimally invasive groin dissection for melanoma. Ann Surg Oncol. 2010;17:731–7.

    Article  PubMed  Google Scholar 

  45. Abbott AM, Grotz TE, Rueth NM, Hernandez Irizarry RC, Tuttle TM, Jakub JW. Minimally invasive inguinal lymph node dissection (MILND) for melanoma: experience from two academic centers. Ann Surg Oncol. 2013;20:340–5.

    Article  PubMed  Google Scholar 

  46. Dossett LA, Castner NB, Pow-Sang JM, et al. Robotic-assisted transperitoneal pelvic lymphadenectomy for metastatic melanoma: early outcomes compared with open pelvic lymphadenectomy. J Am Coll Surg. 2016;222:702–9.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Stuiver MM, Djajadiningrat RS, Graafland NM, Vincent AD, Lucas C, Horenblas S. Early wound complications after inguinal lymphadenectomy in penile cancer: a historical cohort study and risk-factor analysis. Eur Urol. 2013;64:486–92.

    Article  PubMed  Google Scholar 

  48. Mortenson MM, Xing Y, Weaver S, et al. Fibrin sealant does not decrease seroma output or time to drain removal following inguino-femoral lymph node dissection in melanoma patients: a randomized controlled trial (NCT00506311). World J Surg Oncol. 2008;6:1.

    Article  Google Scholar 

  49. Neuss H, Raue W, Koplin G, Schwenk W, Reetz C, Mall J. A prospective randomized trial: the influence of intraoperative application of fibrin glue after radical inguinal/iliacal lymph node dissection on postoperative morbidity. Eur J Surg Oncol. 2009;35:884–9.

    Article  CAS  PubMed  Google Scholar 

  50. Kwa RE, Campana K, Moy RL. Biology of cutaneous squamous cell carcinoma. J Am Acad Dermatol. 1992;26:1–26.

    Article  CAS  PubMed  Google Scholar 

  51. Brodland DG, Zitelli JA. Mechanisms of metastasis. J Am Acad Dermatol. 1992;27:1–8.

    Article  CAS  PubMed  Google Scholar 

  52. Committee on Guidelines of Care. Task Force on Cutaneous Squamous Cell Carcinoma. Guidelines of care for cutaneous squamous cell carcinoma. J Am Acad Dermatol. 1993;28:628–31.

    Article  Google Scholar 

  53. Johnson TM, Rowe DE, Nelson BR, Swanson NA. Squamous cell carcinoma of the skin (excluding lip and oral mucosa). J Am Acad Dermatol. 1992;26:467–84.

    Article  CAS  PubMed  Google Scholar 

  54. Hitchcock CL, Bland KI, Laney RG III, Franzini D, Harris B, Copeland EM III. Neuroendocrine (Merkel cell) carcinoma of the skin. Its natural history, diagnosis, and treatment. Ann Surg. 1988;207:201–7.

    Google Scholar 

  55. Veness MJ, Morgan GJ, Palme CE, Gebski V. Surgery and adjuvant radiotherapy in patients with cutaneous head and neck squamous cell carcinoma metastatic to lymph nodes: combined treatment should be considered best practice. Laryngoscope. 2005;115:870–5.

    Article  PubMed  Google Scholar 

  56. Kraus DH, Carew JF, Harrison LB. Regional lymph node metastasis from cutaneous squamous cell carcinoma. Arch Otolaryngol Head Neck Surg. 1998;124:582–7.

    Article  CAS  PubMed  Google Scholar 

  57. Khurana VG, Mentis DH, O'Brien CJ, Hurst TL, Stevens GN, Packham NA. Parotid and neck metastases from cutaneous squamous cell carcinoma of the head and neck. Am J Surg. 1995;170:446–50.

    Article  CAS  PubMed  Google Scholar 

  58. Weinberg AS, Ogle CA, Shim EK. Metastatic cutaneous squamous cell carcinoma: an update. Dermatol Surg. 2007;33:885–99.

    CAS  PubMed  Google Scholar 

  59. McAfee WJ, Morris CG, Mendenhall CM, Werning JW, Mendenhall NP, Mendenhall WM. Merkel cell carcinoma: treatment and outcomes. Cancer. 2005;104:1761–4.

    Article  PubMed  Google Scholar 

  60. Gupta SG, Wang LC, Penas PF, Gellenthin M, Lee SJ, Nghiem P. Sentinel lymph node biopsy for evaluation and treatment of patients with Merkel cell carcinoma: the Dana-Farber experience and meta-analysis of the literature. Arch Dermatol. 2006;142:685–90.

    Article  PubMed  Google Scholar 

  61. Fang LC, Lemos B, Douglas J, Iyer J, Nghiem P. Radiation monotherapy as regional treatment for lymph node-positive Merkel cell carcinoma. Cancer. 2010;116:1783–90.

    Article  PubMed  Google Scholar 

  62. Howle JR, Hughes TM, Gebski V, Veness MJ. Merkel cell carcinoma: an Australian perspective and the importance of addressing the regional lymph nodes in clinically node-negative patients. J Am Acad Dermatol. 2012;67:33–40.

    Article  PubMed  Google Scholar 

  63. NCCN clinical practice guidelines in oncology: Merkel cell carcinoma, version 1, 2016. 2016. NCCN.org. Accessed 19 Sept 2016.

    Google Scholar 

  64. Bichakjian CK, Lowe L, Lao CD, et al. Merkel cell carcinoma: critical review with guidelines for multidisciplinary management. Cancer. 2007;110:1–12.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jonathan S. Zager M.D., F.A.C.S. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Perez, M.C., Luu, C., Sarnaik, A.A., Zager, J.S. (2018). Considerations for Nonmelanoma Skin Cancer: Clinical Presentation. In: Delman, K., Master, V. (eds) Malignancies of the Groin. Springer, Cham. https://doi.org/10.1007/978-3-319-60858-7_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-60858-7_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60857-0

  • Online ISBN: 978-3-319-60858-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics