A 48-year-old male with a 2.5 cm squamous cell carcinoma of the left lateral tongue (T2) and a clinically negative neck (cN0) is being evaluated. The depth of invasion measured on histopathology is 6 mm. The most appropriate management of the neck is:
- A Elective neck dissection (levels I-III) ✓
- B Observation with regular follow-up
- C Elective radiotherapy to the neck only
- D Radical neck dissection
Correct answer: A. Elective neck dissection (levels I-III)
Explanation
Elective neck dissection is recommended for oral cavity SCC when the risk of occult metastasis exceeds 15-20%. B depth of invasion of 6 mm carries approximately 20-30% risk of occult nodal metastasis, meeting the threshold for elective neck dissection. Observation is inadequate for this depth. Elective radiotherapy is an alternative but surgery provides definitive pathological staging. Radical neck dissection is excessive for a clinically negative neck.
Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.