A 45-year-old man with T1N0M0 squamous cell carcinoma of the oral tongue (depth of invasion 3 mm) undergoes wide local excision with clear margins. The neck is clinically and radiologically negative. What is the recommended management of the neck?
- A Elective radical neck dissection
- B Observation with regular ultrasound follow-up ✓
- C Elective selective neck dissection (levels I-IV)
- D Elective selective neck dissection (levels I-III)
Correct answer: B. Observation with regular ultrasound follow-up
Explanation
For T1 oral tongue SCC with depth of invasion less than 4 mm (some guidelines use 3-5 mm threshold), the risk of occult cervical metastasis is low (approximately 10-15%). Elective neck dissection is generally recommended when depth of invasion exceeds 4-5 mm. For tumors with DOI < 4 mm and clear margins, observation with regular follow-up (including ultrasound surveillance) is acceptable. Elective neck dissection (levels I-III) is indicated for DOI > 4 mm. The 4 mm cutoff is widely used in clinical practice, though some guidelines use 5 mm.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.