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Background: Buccal mucosal squamous cell carcinoma (BSCC) is the most common oral malignancy. BSCC can be treated with Radiotherapy (RT) or surgery or multimodality treatment. This article deals with RT failure BSCC treated by surgery and its subsequent management. Material and Methods: This is a retrospective analysis done in a tertiary care cancer center. The study included 162 patients, of which 35 were treated for RT failure and 127 underwent a primary surgery. Histopathological factors like tumor stage, grade of differentiation, tumor front, skin involvement, bone involvement, depth of invasion, perineural invasion, lymphovascular emboli, primary resection margin in frozen section, nodal stage, extracapsular extension and lymph node ratio were analyzed and compared for LRR and DFS. Clinical neck nodal status was compared with pathological node status. Results: 2 years DFS following salvage surgery was 54.3% and primary surgery was 71.7 %. Following RT, tumor tends to be poorly differentiated (p=0.036) and with more incidence of perineural invasion (p=0.043). Nodal involvement was less in salvage group (11.4%) but when present, more than 1 nodal station got involved. The accuracy of finding a significant node by palpation in salvage patients was 14.28% compared to 54.3% in a primary setting. Conclusion: BSCC following RT had a poor prognosis. Hence primary surgery must be considered over RT for BSCC. Cervical node palpation was not accurate in salvage patients. Following imaging, if neck dissection is indicated, modified radical neck dissection is to be performed.

Salvage surgery versus primary surgery for buccal mucosal squamous cell carcinoma and the need for neck dissection