Clonal Analysis

Patients with SCCs of the head and neck are at risk of the development of multiple primary SCCs, not only in the head and neck region, but also in the lung. Therefore, it is not always clear whether a patient who has multiple lesions either synchronically or metachronically suffers from one single disseminated disease or from multiple primary cancers. If all tumour deposits show SCC, histology cannot distinguish between both possibilities whereas both situations require different treatment approaches. If histologically similar tumours differ geneti cally, molecular pathology could be decisive in making the distinction. Such a clonal marker should be different in different tumours and not subject to alterations during tumour progression and metastasis. The p53 gene meets these requirements; other markers such as loss of heterozygosity analysis are less stable [271, 347, 358, 359]. Only in tumours lying close to each other p53 mutation analysis may be unreliable as separate tumours developing within a single neoplastic field may have the same p53 mutation [50]. This, however, does not detract from the main value of p53 gene analysis as a tool to distinguish between lung lesions as distant metastasis from SCCs of the head and neck or second primary cancer in the lung.

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