2
Key Points
➤ Management decisions for squamous cell carcinoma of
unknown primary (SCCUP) are best decided in the context of a
multidisciplinary tumor board and with careful consideration of
human papillomavirus (HPV) status, disease burden and distribution
in the neck, a patient's overall health and well-being, potential
treatment-related toxicity, and rehabilitation potential for functional
recovery.
Preoperative Evaluation
➤ 1.1 Patients undergoing evaluation for a neck mass suspicious for
squamous cell carcinoma should undergo a thorough history and
physical examination including fiberoptic laryngoscopy that may be
complemented with advanced visualization techniques such as narrow
band imaging (NBI) to facilitate identification of the anatomic location
of the primary tumor and to inform potential therapeutic management
options. (Moderate recommendation; IC-B-L)
➤ 1.2 Fine-Needle aspiration or core biopsy of a clinically suspicious
neck mass should be performed. (Strong recommendation; EB-B-I)
➤ 1.3: High-risk human papillomavirus (HR-HPV) testing should be done
routinely on level II and III SCCUP nodes. Epstein-Barr virus (EBV)
testing should be considered on HPV-negative metastases. (Moderate
recommendation; EB-B-I)
Note: HR-HPV testing may be done non-routinely for squamous cell carcinoma
metastases at other nodal levels when clinical suspicion is high.
➤ 1.4: Contrast enhanced computed tomography (CECT) of the
neck should be the initial test for work-up of metastatic cervical
lymphadenopathy. (Strong recommendation; EB-B-I)
➤ 1.5: If a primary is not evident on clinical examination and CECT,
positron emission tomography (PET)-CT should be the next diagnostic
step. (Strong recommendation; EB-B-I)
