Abstract
The majority of secondary neck metastases of oral squamous cell carcinomas appear within one year after primary treatment. A rare case of upper gingival carcinoma with secondary neck metastasis occurring 3 years and 11 months after primary tumor resection is reported. The patient was a 67-year-old male who underwent preoperative chemotherapy and local tumor resection for a squamous cell carcinoma of the left upper gingiva (T1N0M0) . Three years and 11 months after the primary tumor resection, metastatic tumors were found in the left neck region. Radical neck dissection was immediately performed for these tumors, but the patient died as a result of the recurrence of neck tumors. Histological examination showed that both primary and metastatic tumors belonged to type 4D cancer invasion as classified by Yamamoto and Kohama. This late development of neck metastasis suggested that the cancer cells in the lymph nodes can be dormant for a long period followed by sudden and aggressive growth. In view of the clinical course of this case, prophylactic neck dissection for patients with type 4D cancer invasion is recommended.
