SCC of the tongue: Tends to occur in middle-aged males: With a history of tobacco and alcohol use However, there is a subset of patients who tend to be 20 to 40 years of age: With no known risk factors: Cancer in this group tends to be more aggressive: It carries a poor prognosis despite appropriate therapy The rate of cervical node metastasis is high: Even in T1 or T2 primary cancers: Multiple studies have found that the increasing rate of metastasis: Is seen in tumors that have a vertical depth of invasion greater than 3 mm (Depth of Invasion / DOI) The initial treatment can be: Surgical or with radiation A surgical excision: Is favored for most patients due to the ability to obtain adequate margins: While still preserving articulation and the ability to swallow T1 and T2 cancers: Can be treated with a partial glossectomy: With the goal of attaining a 1 cm to 1.5 cm cuff of normal tissue around the lesion in all directions T3 and T4 lesions: Tend to involve adjacent structures such as the floor of the mouth or mandible: These lesions tend to require a hemiglossectomy or total glossectomy to achieve an adequate margin: Further, these patients may require a segmental mandibulectomy or floor of the mouth resection to adequately resect the tumor Management of the clinically / radiographically N0 neck: Tends to be more aggressive in even T1 / T2 cancers: The reason for this is that even early-stage cancer tends to have a high rate of nodal metastasis: With some studies reporting a rate as high as 30% If the depth of invasion is 4 mm: Should be recommended in the clinically / radiographically N0 neck: It should even be considered if the depth of invasion is at least 3 mm Selective neck dissection: Should include levels I to IV in a clinically / radiographically negative neck #Arrangoiz #CancerSurgeon #SurgicalOncologist #HeadandNeckSurgeon #ThyroidSurgeon #ParathyroidSurgeon #BreastSurgeon #MSMC #MountSinaiMedicalCenter #Miami #Mexico (at Mount Sinai Medical Center of Florida) https://www.instagram.com/p/CoiQ_NhPzVz/?igshid=NGJjMDIxMWI=