8
Systemic Therapy
Figure 1. Diagnosis & Management Algorithm of SCCUP
in the Head and Neck
History and
physical
examination
a
PET-CT
Contrast-enhanced
CT of the neck for
metastatic cervical
lymphadenopathy
Boxes with dotted lines indicate that the level of obligation is moderate.
a
is includes office endoscopy which may be complemented by narrow band imaging.
b
HR-HPV testing may be done non-routinely far squamous cell carcinoma metastases at other nodal
levels when clinical suspicion is high.
c
Bilateral palatine tonsillectomy may be considered according to clinical suspicion, at the discretion
of the surgeon.
d
Bilateral palatine tonsillectomy aer bilateral lingual tonsillectomy should be avoided.
e
If a primary is identified, refer to appropriate ASO guideline of primary site.
Suspicious neck mass
No primary identified
• High-risk (HR)-HPV testing
for level II and III SCCUP
nodes
b
• EBV testing should be
considered on HPV-negative
metastases
Fine-needle
aspiration or core
biopsy
