Patterns of stress coping and depression among patients with head and neck cancer: A Japanese cross-sectional study.

OBJECTIVE: Patients with head and neck cancer (HNC) experience many stressful problems with breathing, eating, swallowing, and/or speaking. The aim of this study was to (a) identify the clusters of HNC patients based on their stress coping strategies and (b) evaluate the differences in clinical data and depression among the identified HNC patients' coping clusters. METHODS: We conducted a single-center, cross-sectional study with self-completed questionnaires for patients with HNC between April and August 2013. We measured stress coping (an abbreviated version of the COPE Inventory: Brief COPE) and depression (the Japanese version of the Beck Depression Inventory-II: BDI-II). RESULTS: Of the 116 patients who completed all the questionnaires, 81 (69.8%) participants were 60 to 79 years old and 105 (90.5%) were men. Cluster analysis based on the standardized z score of Brief COPE showed that patients were classified into 3 clusters, labeled "dependent coping," "problem-focused coping," and "resigned coping." The ANOVA revealed that depression (BDI score) was significantly higher in the dependent-coping cluster compared with the problem-focused coping. CONCLUSIONS: This study indicates that patients with a dependent-coping pattern may account for the largest HNC population and are likely to suffer from depression. Dependent coping includes smoking, drinking, seeking support, or engaging self-distraction. In the future, we should develop psychological intervention programs focused on coping strategies and enhancement of the support system for patients with HNC.

Indication for and Limitation of the Facial Dismasking Flap Approach for Skull Base Surgery to Achieve the Best Esthetical and Functional Results.

BACKGROUND: The facial dismasking flap (FDF) approach to operations on the deep skull base region consists of a coronal incision and a circumpalpebral incision. This approach provides a wide surgical field for extirpation of deep extended craniofacial tumors without leaving any undesirable scars on the face. Therefore, the FDF approach can provide satisfactory esthetical and functional results. Meanwhile, in some cases, especially in patients with a history of skull base surgery or orbital extension, patients are not fully satisfied even when the FDF approach is used. In this study, we evaluated the indication for and limitation of the FDF approach. METHODS: We reviewed 26 patients who underwent the FDF approach for skull base surgery. The patients were 16 men and 10 women, and average age was 37 years. Of these patients, 21 were treated using a hemi-FDF approach, and the remaining 5 were subjected to a bilateral FDF approach. Patients were divided into 2 groups in this study: group A (11 patients), patients with no history of skull base surgery and orbital extension; and group B (15 patients), patients with a history of skull base surgery and/or orbital extension. RESULTS: There was no FDF loss or facial palsy in either group A or group B. In group A, there was no lagophthalmos or scar contracture of the eyelid. In group B, there were 5 cases (33%) of ectropion and lagophthalmos and 7 of eyelid scar contracture (46%). As for esthetical evaluation, group B showed a significantly higher rate of facial asymmetry than group A. Moreover, in group A, the total ratings for above average reached 90.9%, whereas in group B, nearly half of the patients (48.9%) gave ratings of fair and poor. CONCLUSIONS: The FDF approach could be a good option for skull base surgery. In particular, patients without a history of skull base surgery and orbital extension could obtain satisfactory esthetical and functional outcomes. However, the procedure had limited effectiveness for patients with a history of skull base surgery or orbital extension because esthetical and functional outcomes inevitably became worse.

Use of Intraoperative Fluorescent Indocyanine Green Angiography for Real-Time Vascular Evaluation of Pericranial Flaps.

BACKGROUND: Pericranial flaps (PCFs) have been widely used for skull base reconstruction. The key to successful skull base reconstruction using PCF depends on flap vascularity, but there have been no reports describing the real-time vascularity of PCF. In this study, we performed intraoperative fluorescent indocyanine green angiography to evaluate the real-time vascularity and viability of PCF and to estimate the reliability of this flap. METHODS: Eleven anteriorly based PCF (with a bilateral pedicle, ipsilateral pedicle, and random-pattern flap) and 11 laterally based PCF (with and without temporal muscle) were included in this study. The flap vascularity of each flap type considering the patients' background was evaluated using indocyanine green angiography intraoperatively. RESULTS: Anteriorly based PCF had significantly better vascularity compared to laterally based PCF. In anteriorly based PCF, there was no significant difference in vascularity between PCF with bilateral pedicles and an ipsilateral pedicle. In laterally based PCF, PCF without temporal muscle showed a wider vascular area compared to PCF with temporal muscle. As for the patient background, those older than 45 years, body mass index more than 25, and who were smokers tended to have lower vascularity. Preoperative radiation therapy did not show any significant differences in terms of flap vascularity. CONCLUSIONS: Anteriorly based PCF had significantly better vascularity compared to laterally based PCF and seemed safer to harvest regardless of flap pedicle type. Also, the feasibility of harvesting muscle sparing laterally based PCF was indicated. Finally, being older than 45 years, a body mass index more than 25, or being a smoker might increase the risk of reducing flap vascularity.

Feasibility and Advantage of a Muscle-Sparing Laterally Based Pericranial Flap.

BACKGROUND: For a safe and reliable middle skull base reconstruction, the temporalis muscle flaps or pericranial-temporalis muscle flaps have usually been used as the first-choice in clinical practice. But these flaps have an inevitable disadvantage, namely, temporal hollowing. To address this problem, in this study, the authors describe the feasibility and advantages of using a muscle-sparing laterally based pericranial flap. METHOD: The authors reviewed 19 patients who had undergone middle skull base reconstruction using laterally based pericranial flaps. There were two types of these flaps. One was the conventional type: a laterally based pericranial flap combined with the temporoparietal fascia and temporal muscle, that is a conventional laterally based pericranial flap (C-PCF). The other was the muscle-sparing type: a laterally based pericranial flap combined with the temporoparietal fascia, but sparing and preserving the temporal muscle (MS-PCF). The first 9 patients were reconstructed with a C-PCF and the latter 10 patients were reconstructed with an MS-PCF. RESULTS: There was no significant difference between C-PCF and MS-PCF as regards reconstructive time and postoperative hospital stay. In addition, there was no significant difference between C-PCF and MS-PCF in regard to perioperative complications. The rate of temporal hollowing did not reach a significant difference; MS-PCF patients tended to have less temporal hollowing (10%) compared with C-PCF patients (55.6%). DISCUSSION: An MS-PCF could provide safe and reliable skull base reconstruction without lengthening reconstructive time or increasing complications. Moreover, an MS-PCF improves the esthetical results of surgery on skull base patients and provides an extra option for other reconstructive procedures by preserving the temporal muscle.

Persistence of psychological distress and correlated factors among patients with head and neck cancer.

OBJECTIVE: Many patients with head and neck cancer (HNC) suffer from psychological distress associated with dysfunction and/or disfigurement. Our aim was to evaluate the ratio of patients with persistence of psychological distress during hospitalization and identify the predictors of persistence or change in psychological distress among HNC patients. METHOD: We conducted a single-center longitudinal study with self-completed questionnaires. We evaluated psychological distress (the Hospital Anxiety and Depression Scale; HADS) and functional level (the Functional Assessment of Cancer Therapy-Head and Neck Scale; FACT-H&N) among patients during hospitalization at the Medical Hospital of Tokyo Medical and Dental University. RESULTS: Of 160 patients, 117 (73.1%) completed the questionnaire at both admission and discharge. Some 42 (52.5%) patients reported persistent psychological distress. The physical well-being of patients with continued distress was significantly lower than that of other patients (21.7 ± 4.7, 19.4 ± 6.1, 19.5 ± 5.4; p < 0.01), and the emotional well-being of patients with continued distress was significantly lower than that in patients with no distress and reduced distress (22.3 ± 3.5, 20.5 ± 2.5; p < 0.01). Significant of results: Impaired physical and emotional function appears to be associated with persistent psychological distress among HNC patients. Psychological interventions focused on relaxation, cognition, or behavior may be efficacious in preventing such persistent distress.

Clinicopathological significance of androgen receptor, HER2, Ki-67 and EGFR expressions in salivary duct carcinoma.

BACKGROUND: Salivary duct carcinoma (SDC) is a highly aggressive disease which often metastasizes to distant sites, and there is no established standard therapy for this systemic disease. Given that SDC is biologically similar to breast and prostate cancer, anti-androgenic receptor (AR) and anti-human epidermal growth factor receptor 2 (HER2) therapies have the potential to exert effects, not only on patients with breast and prostate cancer but also on those with SDC. METHODS: The expression levels of HER2, epidermal growth factor receptor (EGFR), Ki-67, and AR were assessed in 32 patients with SDC, and their correlations with overall survival (OS) and disease-free survival (DFS) were analyzed retrospectively. SDC was classified into five subtypes using a method similar to that used for breast cancer. RESULTS: Anti-AR, HER2, and EGFR were positive in 23 (71.9 %), 14 (43.8 %), and 26 (81.3 %) cases, respectively. One or more of these 3 factors were positive in 30 (93.8 %) cases. The Ki-67 labeling index was greater than 15 % in all cases. While molecular status did not correlate with OS, EGFR and AR positivity were significantly associated with DFS in univariate analysis. Multivariate analysis revealed that EGFR was the only independent predictor of DFS. CONCLUSIONS: The statuses of some molecules are useful to predict DFS in patients with SDC. Ki-67 overexpression suggests that cytotoxic agents are effective for SDC. Since the majority of SDCs express AR, HER2, and/or EGFR, assessing and targeting these molecules are promising strategies to improve the prognosis of unresectable, metastatic or recurrent SDC, and a classification system according to the molecular expression status may be useful to select appropriate therapy.

Reliability and validity of the Head and Neck Cancer Inventory (HNCI) in Japanese patients.

OBJECTIVE: This project evaluated the psychometric properties of a translated version of the Head and Neck Cancer Inventory (HNCI) for use with Japanese patients. The HNCI is a measure for assessing the quality of life (QoL) of head and neck cancer patients and survivors. The present study was aimed at investigating the reliability and validity of this translated instrument. METHOD: Some 165 patients with head and neck cancer (HNC) were enrolled at the Tokyo Medical and Dental University Hospital. The instrument's internal consistency and test-retest reliability were evaluated. Criterion-related validity was assessed by correlations between the HNCI and the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) scales. RESULTS: Some 29 of the 30 items in the original version were selected to comprise the Japanese version of the HNCI (Japanese HNCI). Investigation of criterion-related validity using the FACT-H&N demonstrated significant correlations (Spearman's ρ = 0.47-0.63). The value of Cronbach's α for each subscale ranged from 0.84 to 0.87. Test-retest reliability showed an intraclass correlation coefficient (ICC) of 0.62-0.79. SIGNIFICANCE OF RESULTS: The reliability and validity of the Japanese HNCI were evaluated. Although its classification is different from the original U.S. version, the Japanese HNCI is a self-administered questionnaire that can assess quality of life (QoL) in patients with head and neck cancer.

[Combined Anterior Craniofacial Resection for Locally Advanced Ethmoid Carcinomas].

OBJECTIVE: Carcinoma of the ethmoid sinus is very rare, and treatment for locally advanced tumors remains as a formidable challenge to the clinician. We reviewed cases of ethmoid carcinoma in which anterior craniofacial resection had been undertaken and evaluated the safety and validity of the operative methods. METHODS: We retrospectively reviewed 13 patients with ethmoid carcinoma who underwent combined anterior craniofacial resection. We evaluated the surgical procedures, complications, outcomes, local recurrence, and the survival rate. RESULTS: Coronal incision and anterior craniotomy were performed in all cases. Four out of 13 cases underwent ipsilateral orbital exenteration due to involvement of the orbital contents. There were no potentially fatal complications, except for two cases of epidural abscesses which were successfully cured. Positive surgical margins were observed in 6 patients, and they received postoperative radiotherapy and/or chemotherapy. Local recurrences occurred in 4 cases, and 3 died at 9, 11, and 49 months after the surgery. Distant metastasis was not observed during the observation period. The overall 5-year survival rate was 75.2% (Kaplan-Meier method). CONCLUSION: These tumors were safely removed without severe complications and postoperative mortality. Combined anterior craniofacial resection is an effective and safe option for treatment of locally advanced ethmoid carcinomas after various preoperative treatments.

Diffusion-weighted magnetic resonance neurography for parapharyngeal schwannomas: preoperative determination of the originating nerves.

OBJECTIVE: The aim of this study was to assess the feasibility of diffusion-weighted (DW) magnetic resonance neurography (MRN) for determining the originating nerve of parapharyngeal schwannomas preoperatively. METHODS: Six patients who underwent DW-MRN preoperatively for a parapharyngeal schwannoma were studied. Prediction of the originating nerve was performed. With the conventional method, a tumor showing "separation" between the internal jugular vein and carotid artery was determined to originate from the vagus nerve, with "no separation" from the sympathetic chain. With DW-MRN, the relationships between the vagus nerve and sympathetic chain to the tumor were characterized as "connected" or "dislocated." A nerve connected to the tumor was determined as the origin. RESULTS: Surgeries revealed that the origins included 1 vagus nerve and 5 sympathetic chains. Using a conventional method, all 6 cases were diagnosed correctly, whereas DW-MRN successfully predicted only 4 cases with a sympathetic chain origin. CONCLUSIONS: The DW-MRN is a feasible approach for determining an originating nerve.

Large nasopharyngeal inverted papilloma presenting with rustling tinnitus.

Tinnitus is a common symptom caused by numerous diseases. The etiology is unknown in most cases; however, nasopharyngeal lesions may cause a certain tinnitus. We herein report a case of nasopharyngeal inverted papilloma which presents with rustling tinnitus as the sole initial symptom. The tympanic membrane was intact, and results of hearing test and impedance audiometry were normal. However, sonotubometry showed a complete blockage of the Eustachian tube. A large tumor was found that originated from the choana and occupied the nasopharynx which caused a rustling sound when she swallowed or spoke. Tinnitus totally subsided after removal of this tumor. To our knowledge, the tumor origin and presenting symptom of this case are very rare, and nasopharyngeal examination is required in the diagnosis of unknown hearing symptoms.

Nasopharyngeal pleomorphic adenoma presenting as otitis media with effusion: case report and literature review.

Most tumors arising in the nasopharynx are malignant and frequently develop otitis media with effusion (OME). On the contrary, benign nasopharyngeal tumors are very rare, and pleomorphic adenoma, which is a benign mixed tumor of the nasopharynx, is also rarely encountered. We herein report a case of nasopharyngeal pleomorphic adenoma which initially presented as OME. This tumor completely blocked the orifice of the Eustachian tube but was removed by a combination of transnasal and transoral endoscopic resection. A defect in the mucous membrane was covered with polyglycolic acid sheet and fibrin glue. Mucous membrane completely covered the exposed tubal cartilage without adhesion near the tubal orifice. OME and hearing loss completely subsided 3 months after the surgery. She was disease-free 2 years after the surgery. Use of polyglycolic acid sheet could be a feasible mesh for closure of surgical defect without scarring, and it also led to healing of OME.

[What is the role of otolaryngologists in deglutition practice?--A survey for medical practitioners in different fields].

The advent of a super aging society is causing a rapid increase in the number of patients with dysphagia, and, in response, the use of percutaneous endoscopic gastrostomy (PEG) has become markedly widespread over the past decade. As the result of its rapid spread, PEG is controversial both ethically and economically, and, in the revision of medical treatment fees for 2014, the preoperative deglutition usability test of all cases is fixed for the full amount request requirements of gastrostomy. Thus, the demands on dysphagia practice are rising. Therefore, we conducted a survey of the dysphagia practice of otolaryngologists, doctors, and speech therapists in charge of dysphagia practice in hospitals, home medical care clinics, and dental offices in Itabashi-ku, Tokyo, and we considered the role of otolaryngologists in dysphagia practice. According to the survey, the roles that are expected of otolaryngologists in dysphagia practice are the evaluation of swallowing function using videoendoscopic examination of swallowing in over 50% of home medical care clinics and dental offices. On the other hand, surgical treatment is expected of otolaryngologists in over half in the hospital group. A total of 64% of the home care clinic group and 47% of the dental group did not coordinate with otolaryngologists in dysphagia practice because there are no otolaryngologists to consult. The home care clinic group indicated a demand of the swallowing function test in short-term admission or home practice. In the survey of departments of otolaryngology in hospitals or otolaryngology clinics, 40% of these institutions evaluate deglutition, while the other institutions did not perform evaluations because of the lack of human resources or deficient facilities. The otolaryngologist specializes in the laryngopharynx where aspiration occurs, and not only diagnoses local organic disease, but also directs the patient to a doctor in an appropriate department on the basis of understanding the patient's background diseases. We conclude that organized participation and leadership in this region are urgent tasks of otolaryngologist.

A Dermatitis Control Program (DeCoP) for head and neck cancer patients receiving radiotherapy: a prospective phase II study.

PURPOSE: We speculated that a systematic program to manage radiation dermatitis might decrease the incidence of severe or fatal cases in head and neck cancer patients receiving radiotherapy. Here, we conducted a prospective phase II study to clarify the clinical benefit of a Dermatitis Control Program (DeCoP) that did not use corticosteroids. PATIENTS AND METHODS: Head and neck cancer patients scheduled to receive definitive or postoperative radiotherapy were enrolled. Radiation dermatitis was managed with a DeCoP consisting of a three-step ladder: Step 1, gentle washing; Step 2, gentle washing and moistening of the wound-healing environment; Step 3, prevention against infection, gentle washing and moistening of the wound-healing environment. The primary endpoint was the incidence of grade 4 dermatitis. RESULTS: A total of 113 patients were registered between January 2009 and February 2010. Eighty patients received radiotherapy as an initial approach, while the remaining 33 received radiotherapy postoperatively. Grade 3 and 4 dermatitis events occurred in 11 (9.7%) and 0 (0%, 95% confidence interval 0-3.2%) patients, respectively. Median radiation dose at the onset of grade 2 dermatitis was 61.5 Gy (range 36-70 Gy) and median period between onset and recovery was 14 days (range 1-46 days). CONCLUSION: The Dermatitis Control Program has promising clinical potential. Radiation dermatitis might be manageable if gentle washing and moistening of the wound-healing environment is done.

Tongue reconstruction with minimal donor site morbidity using a deep inferior epigastric perforator (DIEP) free flap in a 6-year-old girl.

Tongue reconstruction was performed using a deep inferior epigastric perforator (DIEP) free flap in a 6-year-old girl with undifferentiated sarcoma of the tongue. After hemi-glossectomy with upper neck dissection, a 3-lobed DIEP free flap was used for the reconstruction. Donor site was closed primarily with suturing umbilicus in proper position. No flap loss, leakage, or infection occurred. Postoperatively, the patient was able to consume a normal diet without difficulty or aspiration and displayed good speech function. No donor site morbidity, e.g., herniation or bulging, was observed, and the patient was able to perform their normal daily activities. DIEP flaps provide a pliable skin paddle, an adequate amount of adipose tissue, and reduced donor site morbidity, even in children. We did not have any difficulty harvesting the DIEP flap or with the microvascular anastomosis. We consider DIEP free flaps to be the ideal option for pediatric tongue reconstruction.

Prevalence of esophageal cancer during the pretreatment of hypopharyngeal cancer patients: routinely performed esophagogastroduodenoscopy and FDG-PET/CT findings.

BACKGROUND: The prevalence of esophageal cancer accompanied by hypopharyngeal cancer (HPC) is high and increasing rapidly in Asia. The purpose of this prospective study was to evaluate the prevalence of esophageal cancer during the pretreatment of HPC patients who were routinely examined using esophagogastroduodenoscopy (EGD) and 18F-fluorodeoxyglucose/computed tomography (FDG-PET/CT) and to discuss the utility of these examinations. MATERIAL AND METHODS: Between September 2005 and September 2010, 33 patients with newly diagnosed HPC (all with squamous cell carcinoma) underwent EGD (after a conventional endoscopy, iodine staining was performed) and FDG-PET/CT examinations. We evaluated the prevalence of esophageal cancer among HPC patients according to the EGD findings and determined the sensitivity of FDG-PET/CT for the detection of esophageal primary tumors for each clinical T classification. RESULTS: In 17 of the 33 patients (51.5%), 29 biopsy-proven esophageal squamous cell carcinomas were diagnosed using EGD. In eight of the 17 (47.1%) patients, two or more esophageal cancer lesions were diagnosed. Twenty-four of the 29 (82.8%) lesions were superficial esophageal cancers, and the remaining five (17.2%) lesions were advanced esophageal cancers. In six of the 29 (20.7%) esophageal cancer lesions that were detected using FDG-PET/CT, only one of the 29 (3.4%) lesions was evaluated as being equivocal; the remaining 22 (75.9%) lesions were not detected. The distribution of the clinical T classifications detected using FDG-PET/CT was as follows: T1a, 0/21 (0%); T1b, 1/3 (33%); and T3, 5/5 (100%). CONCLUSIONS: The prevalence of esophageal cancer during the pretreatment of HPC patients was 51.5%; this prevalence was higher than that in previous reports. We believe that the increasing proportion of superficial lesions (82.8%) detected using iodine staining and EGD may have led to the relatively high prevalence. FDG-PET/CT detected only 20.7% of the esophageal cancers, although FDG-PET/CT is capable of detecting unexpected primary malignant tumors other than esophageal cancer.

Usability of the middle temporal vein as a recipient vessel for free tissue transfer in skull-base reconstruction.

In skull-base reconstruction, finding appropriate recipient veins is difficult if the patient has undergone previous craniotomy or requires multiple drainage vessels, because of postoperative scarring and the limited number of veins in the temporal region. Therefore, we have used the middle temporal vein (MTV) to overcome these problems. We examined the presence and caliber of the MTV in 12 patients undergoing skull-base reconstruction. The MTV was identified in all cases and used for reconstruction, alone or with the superficial temporal vein (STV), in 8 patients without postoperative flap loss and was only measured in 4 patients. The caliber of the MTV was significantly greater than that of the STV, and there was no significant difference between the usage of the MTV and STV in the length of reconstruction time. Therefore, the MTV is of an appropriate caliber, and its use does not require complicated procedures as alternative recipient vessels.

[Thiel's method of embalming and its usefulness in surgical assessments].

When we assess anatomical problems and the safety and effectiveness for performing a difficult surgical procedure or planning novel surgical approaches, preoperative human dissections are very helpful. However, embalming with the conventional formaldehyde method makes the soft tissue of the cadaver harder than that of a living body. Therefore, the cadaver embalmed with conventional formaldehyde is not appropriate for dissections when assess surgical approaches. Thiel's method is a novel embalming technique, first reported by W. Theil in 1992. This method can preserve color and softness of the cadaver without risk of infections. We have used cadavers embalmed with Thiel's method for preoperative assessments and have confirmed the usefulness of this method especially for the prevention of complications or in assessing surgical approaches. The cadaver embalmed with this method has several advantages over other embalming methods and it might be also useful for the developments of new surgical devices or evaluation of a surgeon's skill.

Reliability of and indications for pericranial flaps in anterior skull base reconstruction.

Owing to changes in the treatment of skull-base tumors, such as perioperative radiotherapy and advances in approaching the skull base, the use of pericranial flaps should be reconsidered. Therefore, we reviewed the reliability of and indications for pericranial flaps in 26 cases in terms of patient background, the effects of preoperative and postoperative treatment, and the pattern of blood circulation. Flaps were harvested as 25 anteriorly based and 4 laterally based. As a result, postoperative complications were observed in 4 patients. No other risk factors, except for heavy smoking, were observed relative to patient background. Sixteen patients had perioperative radiotherapy, and complication rate was significantly higher in patients with preoperative radiotherapy than patients without preoperative radiotherapy (P=0.014). However, no complications, such as cerebral spinal fluid leakage and intracranial infection, were observed in patients receiving postoperative radiotherapy. Laterally based pericranial flaps had a high complication rate (25%), but it was not significantly higher than anteriorly based flaps (P=0.467). Five anteriorly based flaps were harvested with less feeding vessels as usual because of applying dismasking flap approach, but it did not lead to increasing in complication rate. We conclude that a pericranial flap can be used for skull base reconstruction even if postoperative radiotherapy is planned but might be avoided for patients who have received preoperative radiotherapy. In addition, particular care and flap design should be taken to preserve sufficient vascularity when pericranial flaps are raised as laterally based and less feeding vessels as usual.

A Case of Huge Cutaneous Verrucous Carcinoma of the Neck.

Verrucous carcinoma (VC) is a rare subtype of squamous cell carcinoma. VC commonly occurs in the mucosa, but rarely occurs in the skin. The treatment for VC is surgical removal of the tumor. Because lymph node metastasis of VC is rare, the indications for prophylactic neck dissection for cutaneous VC of the neck are controversial. Here, we present the case of a 68-year-old man with a huge cutaneous VC of the neck and the long-term clinical course. The tumor occupied the entire right cervical skin, with suspected lymph node metastasis in the affected neck. Tumor resection and neck lymph node dissection were performed. Pathological examination revealed cutaneous VC with invasion to the adjacent tissues and no lymph node metastasis. Cutaneous VC of the neck is likely to grow locally without regional lymph node metastasis regardless of the long-term course and the size of the tumor.