Diagnosis and Management of Squamous Cell Carcinoma of Unknown Primary in the Head and Neck

Patients undergoing evaluation for a neck mass suspicious for squamous cell carcinoma should undergo a thorough history and physical examination including fiberoptic laryngoscopy that may be complemented with advanced visualization techniques such as narrow band imaging (NBI) to facilitate identification of the anatomic location of the primary tumor and to inform potential therapeutic management options. ( IC , B , L , M )

Fine-Needle aspiration or core biopsy of a clinically suspicious neck mass should be performed. ( EB , B , I , S )

High-risk human papillomavirus (HR-HPV) testing should be done routinely on level II and III SCCUP nodes. Epstein-Barr virus (EBV) testing should be considered on HPV-negative metastases. ( EB , B , I , M )

Contrast enhanced computed tomography (CECT) of the neck should be the initial test for work-up of metastatic cervical lymphadenopathy. ( EB , B , I , S )

If a primary is not evident on clinical examination and CECT, positron emission tomography (PET)-CT should be the next diagnostic step. ( EB , B , I , S )