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P297 Metastatic potentials of salivary duct carcinoma correlate with high expression of c-erb-B2 protein
Poster abstracts, Sunday 20 May
N.E. Elneser1 , G.H. Kalluf1 , P.R. de Faria1 , R.A. Lima2 , S.J. Silva1 , M.F. Nascimento2 , A.L. Eisenberg2 , F.L. Dias2 , A.M. Loyola1 *. 1 Federal University of Uberlˆ andia, Brazil, 2 National Institute of Cancer, Brazil Introduction: Salivary gland tumors rarely affect children and adolescents. There are few statistics about such cases in the Brazilian population. The present descriptive work is a retrospective compilation of the epithelial salivary gland tumors (ESGT) in patients under 18 years-old attended through 1997 to 2005 at the Brazilian National Institute of Cancer, the main governmental center for cancer statistics in the country. Methods: After new histological assessment for diagnostic confirmation, medical files were assessed to gather demographic and clinical data from the patients. Results: Forty-one cases were found, representing 4.4% of the entire sample of ESGT at the Institution. The ratio between males and females was 1:1.7. Patients in the second decade of life were prevalent. Major salivary glands were more frequently affected (80.5% of the entire sample), with the parotid gland being involved in 25 patients. The overall mean size of the lesions was 2.8 cm (±1.7 cm), varying from 0.5 to 8 cm width. The average evolution time before first attendance at the institution was 24.1 months (± 31.0 months), varying from one months to 14 years. Pain was registered in 26.8% of them. One patient also presented a papilliferous thyroid carcinoma. There was a slight prevalence of benign lesions (51.2% versus 48.8% of malignancies). However, a significant association was found between patients in the first decade of life and malignant tumors. Pleomorphic adenoma was the prevalent entity and the only one benign lesion, and mucoepidermoid carcinoma was the main malignant tumor (75% of this group), followed by acinic cell carcinoma (15%) and adenoid cystic carcinoma (10%). Recurrences were found in two cases (one pleomorphic adenoma and one mucoepidermoid carcinoma). There was no registered death in this patient. Discussion: The observed epidemiologic profile is very similar to those described for other authors. The trend for malignant lesions in the patients in the first decade deserves further investigation. Finally, these malignant ESGT in young patients do not depict a very aggressive behavior. Keywords: salivary gland tumors, malignant tumors, children, adolescent P295 Epithelial salivary gland neoplasms at the Brazilian National Cancer Institute (1997 2005) G.H. Kalluf1 , S.V. Cardoso1 , N.E. Elneser1 , K.C.N. Souza1 , S.J. Silva1 , A.L.A. Eisenbert2 , M.F. Nascimento2 , F.L. Dias2 , A.M. Loyola1 *. 1 Federal University of Uberlˆ andia, Brazil, 2 National Institute of Cancer, Brazil Introduction: There are few statistics about salivary tumors in the Brazilian population. The present descriptive work is a retrospective compilation of the 923 epithelial salivary gland tumors (ESGT) attended through 1997 to 2005 at the Brazilian National Institute of Cancer, the main governmental center for cancer statistics in the country. Methods: After new histological assessment for diagnostic confirmation, medical files were assessed to gather demographic and clinical data from the patients. Results: The ratio between males and females was 1:1.3. The average age of the patients was 50.6 years (±17.4 years), varying from 4 to 92 years-old, with prevalence of patients in the sixth decade of life (22.6% of the sample). One-third of the patients were present smokers, and nearly one-tenth of the entire population was heavy drinkers. Major salivary glands were more frequently affected than minor ones (69.6% versus
30.4%, respectively). The overall mean size of the lesions was 3.8 cm (±2.3 cm), varying from 0.2 to 25 cm width. The average evolution time before first attendance at the institution was 37.2 months (± 61.5 months), varying from one week to 40 years. Tumefaction was registered in 78.5% of the lesions, as well as pain in 27.0% of them. Other primary non-salivary neoplasms were registered for 9.2% of the patients. There was a prevalence of benign lesions (51.7% versus 48.3% of malignancies). The prevalent benign neoplasm was pleomorphic adenoma (73.2% of this group), while the most common malignancies were adenoid cystic carcinoma (24.7% of the malignant lesions), followed by mucoepidermoid carcinoma (21.1%) and adenocarcinoma NOS (15.5%). Discussion: The observed epidemiologic profile is very similar to those described for other countries. However, the investigated institution is mainly directed to treatment of malignant lesions, and this fact may be held responsible for the high proportion of these neoplasms in this work. Keywords: Salivary gland tumors, malignant tumors, benign tumors, salivary gland P296 Mucoepidermoid carcinoma originated in salivary glands: prognostic factors B. Villavicencio, J. Resendiz, F. Gallegos *, S. Labastida. Hospital de Oncologia IMSS, Mexico Introduction: Mucoepidermoid carcinoma (MEC) is the malignant neoplasia most frequently originated in salivary glands. It is formed by 3 components, mucous, squamous cell and cystic and is classified in high, medium and low degrees. Due to the small prevalence of this neoplasia, there is still controversy about the standard of care. Objective: To analyze prognosis factors that have an influence on survival and local control of patients with mucoepidermoid carcinoma originated in salivary glands. Methods: The files of patients with MEC originated in salivary glands and treated during a 15 year period were evaluated; the site of origin, staging, treatment, histological degree, necrosis presence, cystic component and surgical limits were analyzed. The influence of variables in the prognosis was analyzed with the Kaplan Meier method, log-rank test and Cox. Results: 47 patients, 28 women and 19 men. In 32, the tumor originated in major glands and in accessory in 12. 46 patients underwent initial surgical resection followed by radiotherapy according to the stage. The 5 and 10 year global survival was 78.3 and 69.3%, respectively. The 5 year disease free survival was 73.9% and the 10 year 67.5%. The prognosis factors in multiple analysis were: tumor size (T4) (P = 0.0008), nodular metastasis (P = 0.000), high histological degree (P = 0.0002), positive surgical limit (P = 0.000), necrosis (P = 0.005) and intracystic component <20% (P = 0.0002). 32 patients were N0, 22 of them underwent neck dissection, hidden nodular metastasis was found in 11 (50%), 9 with high or intermediate degree and 2 (18%) with low histological degree. Conclusions: The stage (TNM) and histological degree are the two most important prognosis factors in this series; half of the N0 patients with MEC have hidden nodular metastasis therefore elective neck dissection must be included in the treatment on routine basis. Keywords: salivary glands, mucoepidermoid carcinoma P297 Metastatic potentials of salivary duct carcinoma correlate with high expression of c-erb-B2 protein C.H. Baek *, H.S. Jeong, Y.I. Son, M.H. Ko, Y.K. So, M.K. Chung, Y.H. Ko. Sungkynkwan University School of Medicine, South Korea Purpose: to investigate immunohistochemical differences between SDCs with metastasis (M+SDC) and without metastasis (M-SDC).
Poster abstracts
P294 Epithelial salivary gland neoplasms in young patients at the Brazilian National Cancer Institute (1997 2005)
221
222 Material and Methods: Twenty-two cases of salivary duct carcinomas were retrieved from the Salivary Gland Malignancy Data Registry at the Samsung Medical Center. Subjects were reclassified as having M+SDC (14 patients) or M-SDC (8 patients) based on their clinical features. Immunohistochemical profiles were compared between the two groups, which was subsequently confirmed by survival analyses. Result: c-erb-B2 protein expression was higher in M+SDC (92.9%) than M-SDC (12.5%) (p < 0.001). however, expressions of TGF-b, androgen receptor, VEGF and EGFR were similar in two groups. Subsequent survival analyses also showed that elevated c-erb-B2 expression was associated with worse overall and disease-free survival (p = 0.02, p < 0.005) Conclusion: the expression level of c-erb-B2 in SDCs could help predict the possibility of metastasis in clinical courses and the prognosis. This finding implies that c-erb-B2 may play a key role in the regional or distant spread of salivry duct carcinoma. Keywords: salivary duct carcinoma, metastasis, immunohistochemical study, c-erb-B2 protein P298 Detection of the t(11;19)(q21;p13) translocation in Warthin tumors A. Fehr1 , K. R¨ oser2 *, N. Drieschner1 , T. L¨ oning3 , J. Bullerdiek1 . 1 2 University of Bremen, Germany, University Medical Center Hamburg-Eppendorf, Germany, 3 Albertinen-Pathology, Germany The translocation t(11;19)(q21;p13) first has been described in our laboratory and is known to occur in both mucoepidermoid carcinomas (MEC) and rarely for Warthin tumors (WAT), both tumours occurring in the salivary glands. Recently, the breakpoint was cloned and the fusion gene TORC1 (also known as MECT1) MAML2 resulting from this translocation was identified. Generally, WAT and MEC are two salivary gland tumors that do not share clinicopathologic features, and as widely accepted their histogenesis is also different. However, metaplastic WAT are characterized by replacement of a large amount of the formerly epithelium by metaplastic squamous cells, along with regressive changes in the stroma areas. Therefore, misinterpretation of metaplastic WAT for malignancy like squamous epithelial carcinoma is more likely. We have screened a total of 48 WATs for the occurrence of the translocation t(11;19)(q21;p13) by using FISH and RT-PCR. A TORC1 MAML2 fusion transcript was detected only in two WAT, both metaplastic variants. Indeed, our experience and published observations of the t(11;19)(q21;p13) translocation in WAT reveal that only a small subset of WATs are positive, and that these tumors are often classified as infarcted/metaplastic WAT. Keywords: MECT1 MAML2, Warthins tumor, Salivary gland, Translocation t(11;19) P299 Minor salivary gland tumours of the oral cavity and oro-pharynx Tata Memorial Hospital experience A. D’Cruz1 *, R. Metgudmat1 , P. Chaturvedi1 , P. Pai1 , D. Chaukar1 , M. Deshpande1 . 1 Tata Memorial Hospital, India Background: Minor salivary gland tumours are uncommon. They constitute great variety of histomorphologic variation and thus may pose a diagnostic and therapeutic dilemma for head and neck surgeon. Objective: To look at over all survival and locoregional control. Methods: Retrospective review of minor salivary gland tumours of oral cavity and oro-pharynx region treated at our centre during 1990 2000 was carried out. Results: Of 79 evaluable patients, adenoid cystic carcinoma was the commonest histological type (45.6%) and hard palate
Poster abstracts, Sunday 20 May was the commonest site. Locoregional recurrence was seen in 20.3% and distant metastasis in 13.9.% of patients. Median follow-up was 5.47 years and median disease free survival 12.6 years. 5 and 10-year disease free survival was 75% and 70% and 5 and 10-years over all survival was 80% and 90% respectively.Univariate analysis revealed sex, invasion of bone, lympho-vascular invasion, soft tissue invasion and histology type as significant predicators of survival. Multivariate analysis showed sex, invasion of bone, invasion of soft tissue, absence of postoperative adjuvant radiotherapy to be significantly associated with low disease free survival. Conclusion: These tumours have got preponderance for recurrence. Adenoid cystic carcinoma is the most common histologic type and has got preponderance for both recurrence and distant metastasis. Due to late recurrence long term follow up is mandatory. Keywords: minor salivary gland; intraoral, surgical excision; postoperative radiotherapy. P300 Alpha B-Crystallin (ABCrys) a novel biomarker in metastatic cutaneous squamous cell carcinoma of the head and neck K. Lim *, L. DaSilva, W. Coman. University of Queensland, Australia In Australia, incidence of cutaneous SCC is ~321 per 100,000 population. Due to predominant involvement of the head and neck and propensity for lymphatic spread, the most common malignancy involving the parotid gland in Australia is metastatic cutaneous cancer. Current literature has focussed on clinical parameters eg TNM and parotid disease staging, characteristics of the primary, treatment modalities etc. Prognostic biomarkers are described in “head and neck” SCC, but it has not been established that SCCs at different anatomical sites (eg skin, oral cavity, larynx, oesophagus, cervix) are comparable in terms of clinical behaviour and outcome. ABCrys is a member of the small heat shock proteins (sSHSP) family, molecular chaperones preventing aggregation of nascent and stress-accumulated misfolded proteins. It prevents activation of pro-caspase 3, increases microtubular resistance to depolymerization, and is involved in proteasomemediated degradation. Although a major lens protein, it is present in tissues with high oxidative capacity eg heart, skeletal muscle, kidney. ABCrys may participate in development of neuro-degenerative diseases and malignant tumors; it is over-expressed in glial tumors and renal carcinoma. Overexpression may limit efficacy of cancer therapy, presumably by reducing apoptosis. Expression of exogenous ABCrys prevents UVA-induced activation of RAF/MEK/ERK pathway, substantially abrogating UVA-induced apoptosis. In oral SCC, ABCrys was a powerful prognostic marker, independent of nodal status. Apoptosis resistance conferred by ABCrys may contribute to aggressive behavior in basal-like breast carcinomas. We investigated immunohistochemical expression of ABCrys (using two different antibodies) in 37 patients with metastatic cutaneous SCC to the parotid ± neck (33 male, 4 female; age range 35 92 years). Archival tissue sections from the primary lesion, parotid and cervical lymph nodes were examined. Minimum follow up period was five years. Variables associated with ABCrys expression and correlation with other biomarkers was analyzed using the c2 test. Differences were assessed by independent Wilcoxon method, survival rates estimated by Kaplan Meier method and compared using log-rank test. Multivariate survival analysis was performed using Cox proportional hazards model. ABCrys expression was localized to the cytoplasm, and observed in 19 cases with a variable proportion of positive tumor cells. Overexpression correlated with poor prognosis and reduced
N.E. Elneser1 , G.H. Kalluf1 , P.R. de Faria1 , R.A. Lima2 , S.J. Silva1 , M.F. Nascimento2 , A.L. Eisenberg2 , F.L. Dias2 , A.M. Loyola1 *. 1 Federal University of Uberlˆ andia, Brazil, 2 National Institute of Cancer, Brazil Introduction: Salivary gland tumors rarely affect children and adolescents. There are few statistics about such cases in the Brazilian population. The present descriptive work is a retrospective compilation of the epithelial salivary gland tumors (ESGT) in patients under 18 years-old attended through 1997 to 2005 at the Brazilian National Institute of Cancer, the main governmental center for cancer statistics in the country. Methods: After new histological assessment for diagnostic confirmation, medical files were assessed to gather demographic and clinical data from the patients. Results: Forty-one cases were found, representing 4.4% of the entire sample of ESGT at the Institution. The ratio between males and females was 1:1.7. Patients in the second decade of life were prevalent. Major salivary glands were more frequently affected (80.5% of the entire sample), with the parotid gland being involved in 25 patients. The overall mean size of the lesions was 2.8 cm (±1.7 cm), varying from 0.5 to 8 cm width. The average evolution time before first attendance at the institution was 24.1 months (± 31.0 months), varying from one months to 14 years. Pain was registered in 26.8% of them. One patient also presented a papilliferous thyroid carcinoma. There was a slight prevalence of benign lesions (51.2% versus 48.8% of malignancies). However, a significant association was found between patients in the first decade of life and malignant tumors. Pleomorphic adenoma was the prevalent entity and the only one benign lesion, and mucoepidermoid carcinoma was the main malignant tumor (75% of this group), followed by acinic cell carcinoma (15%) and adenoid cystic carcinoma (10%). Recurrences were found in two cases (one pleomorphic adenoma and one mucoepidermoid carcinoma). There was no registered death in this patient. Discussion: The observed epidemiologic profile is very similar to those described for other authors. The trend for malignant lesions in the patients in the first decade deserves further investigation. Finally, these malignant ESGT in young patients do not depict a very aggressive behavior. Keywords: salivary gland tumors, malignant tumors, children, adolescent P295 Epithelial salivary gland neoplasms at the Brazilian National Cancer Institute (1997 2005) G.H. Kalluf1 , S.V. Cardoso1 , N.E. Elneser1 , K.C.N. Souza1 , S.J. Silva1 , A.L.A. Eisenbert2 , M.F. Nascimento2 , F.L. Dias2 , A.M. Loyola1 *. 1 Federal University of Uberlˆ andia, Brazil, 2 National Institute of Cancer, Brazil Introduction: There are few statistics about salivary tumors in the Brazilian population. The present descriptive work is a retrospective compilation of the 923 epithelial salivary gland tumors (ESGT) attended through 1997 to 2005 at the Brazilian National Institute of Cancer, the main governmental center for cancer statistics in the country. Methods: After new histological assessment for diagnostic confirmation, medical files were assessed to gather demographic and clinical data from the patients. Results: The ratio between males and females was 1:1.3. The average age of the patients was 50.6 years (±17.4 years), varying from 4 to 92 years-old, with prevalence of patients in the sixth decade of life (22.6% of the sample). One-third of the patients were present smokers, and nearly one-tenth of the entire population was heavy drinkers. Major salivary glands were more frequently affected than minor ones (69.6% versus
30.4%, respectively). The overall mean size of the lesions was 3.8 cm (±2.3 cm), varying from 0.2 to 25 cm width. The average evolution time before first attendance at the institution was 37.2 months (± 61.5 months), varying from one week to 40 years. Tumefaction was registered in 78.5% of the lesions, as well as pain in 27.0% of them. Other primary non-salivary neoplasms were registered for 9.2% of the patients. There was a prevalence of benign lesions (51.7% versus 48.3% of malignancies). The prevalent benign neoplasm was pleomorphic adenoma (73.2% of this group), while the most common malignancies were adenoid cystic carcinoma (24.7% of the malignant lesions), followed by mucoepidermoid carcinoma (21.1%) and adenocarcinoma NOS (15.5%). Discussion: The observed epidemiologic profile is very similar to those described for other countries. However, the investigated institution is mainly directed to treatment of malignant lesions, and this fact may be held responsible for the high proportion of these neoplasms in this work. Keywords: Salivary gland tumors, malignant tumors, benign tumors, salivary gland P296 Mucoepidermoid carcinoma originated in salivary glands: prognostic factors B. Villavicencio, J. Resendiz, F. Gallegos *, S. Labastida. Hospital de Oncologia IMSS, Mexico Introduction: Mucoepidermoid carcinoma (MEC) is the malignant neoplasia most frequently originated in salivary glands. It is formed by 3 components, mucous, squamous cell and cystic and is classified in high, medium and low degrees. Due to the small prevalence of this neoplasia, there is still controversy about the standard of care. Objective: To analyze prognosis factors that have an influence on survival and local control of patients with mucoepidermoid carcinoma originated in salivary glands. Methods: The files of patients with MEC originated in salivary glands and treated during a 15 year period were evaluated; the site of origin, staging, treatment, histological degree, necrosis presence, cystic component and surgical limits were analyzed. The influence of variables in the prognosis was analyzed with the Kaplan Meier method, log-rank test and Cox. Results: 47 patients, 28 women and 19 men. In 32, the tumor originated in major glands and in accessory in 12. 46 patients underwent initial surgical resection followed by radiotherapy according to the stage. The 5 and 10 year global survival was 78.3 and 69.3%, respectively. The 5 year disease free survival was 73.9% and the 10 year 67.5%. The prognosis factors in multiple analysis were: tumor size (T4) (P = 0.0008), nodular metastasis (P = 0.000), high histological degree (P = 0.0002), positive surgical limit (P = 0.000), necrosis (P = 0.005) and intracystic component <20% (P = 0.0002). 32 patients were N0, 22 of them underwent neck dissection, hidden nodular metastasis was found in 11 (50%), 9 with high or intermediate degree and 2 (18%) with low histological degree. Conclusions: The stage (TNM) and histological degree are the two most important prognosis factors in this series; half of the N0 patients with MEC have hidden nodular metastasis therefore elective neck dissection must be included in the treatment on routine basis. Keywords: salivary glands, mucoepidermoid carcinoma P297 Metastatic potentials of salivary duct carcinoma correlate with high expression of c-erb-B2 protein C.H. Baek *, H.S. Jeong, Y.I. Son, M.H. Ko, Y.K. So, M.K. Chung, Y.H. Ko. Sungkynkwan University School of Medicine, South Korea Purpose: to investigate immunohistochemical differences between SDCs with metastasis (M+SDC) and without metastasis (M-SDC).
Poster abstracts
P294 Epithelial salivary gland neoplasms in young patients at the Brazilian National Cancer Institute (1997 2005)
221
222 Material and Methods: Twenty-two cases of salivary duct carcinomas were retrieved from the Salivary Gland Malignancy Data Registry at the Samsung Medical Center. Subjects were reclassified as having M+SDC (14 patients) or M-SDC (8 patients) based on their clinical features. Immunohistochemical profiles were compared between the two groups, which was subsequently confirmed by survival analyses. Result: c-erb-B2 protein expression was higher in M+SDC (92.9%) than M-SDC (12.5%) (p < 0.001). however, expressions of TGF-b, androgen receptor, VEGF and EGFR were similar in two groups. Subsequent survival analyses also showed that elevated c-erb-B2 expression was associated with worse overall and disease-free survival (p = 0.02, p < 0.005) Conclusion: the expression level of c-erb-B2 in SDCs could help predict the possibility of metastasis in clinical courses and the prognosis. This finding implies that c-erb-B2 may play a key role in the regional or distant spread of salivry duct carcinoma. Keywords: salivary duct carcinoma, metastasis, immunohistochemical study, c-erb-B2 protein P298 Detection of the t(11;19)(q21;p13) translocation in Warthin tumors A. Fehr1 , K. R¨ oser2 *, N. Drieschner1 , T. L¨ oning3 , J. Bullerdiek1 . 1 2 University of Bremen, Germany, University Medical Center Hamburg-Eppendorf, Germany, 3 Albertinen-Pathology, Germany The translocation t(11;19)(q21;p13) first has been described in our laboratory and is known to occur in both mucoepidermoid carcinomas (MEC) and rarely for Warthin tumors (WAT), both tumours occurring in the salivary glands. Recently, the breakpoint was cloned and the fusion gene TORC1 (also known as MECT1) MAML2 resulting from this translocation was identified. Generally, WAT and MEC are two salivary gland tumors that do not share clinicopathologic features, and as widely accepted their histogenesis is also different. However, metaplastic WAT are characterized by replacement of a large amount of the formerly epithelium by metaplastic squamous cells, along with regressive changes in the stroma areas. Therefore, misinterpretation of metaplastic WAT for malignancy like squamous epithelial carcinoma is more likely. We have screened a total of 48 WATs for the occurrence of the translocation t(11;19)(q21;p13) by using FISH and RT-PCR. A TORC1 MAML2 fusion transcript was detected only in two WAT, both metaplastic variants. Indeed, our experience and published observations of the t(11;19)(q21;p13) translocation in WAT reveal that only a small subset of WATs are positive, and that these tumors are often classified as infarcted/metaplastic WAT. Keywords: MECT1 MAML2, Warthins tumor, Salivary gland, Translocation t(11;19) P299 Minor salivary gland tumours of the oral cavity and oro-pharynx Tata Memorial Hospital experience A. D’Cruz1 *, R. Metgudmat1 , P. Chaturvedi1 , P. Pai1 , D. Chaukar1 , M. Deshpande1 . 1 Tata Memorial Hospital, India Background: Minor salivary gland tumours are uncommon. They constitute great variety of histomorphologic variation and thus may pose a diagnostic and therapeutic dilemma for head and neck surgeon. Objective: To look at over all survival and locoregional control. Methods: Retrospective review of minor salivary gland tumours of oral cavity and oro-pharynx region treated at our centre during 1990 2000 was carried out. Results: Of 79 evaluable patients, adenoid cystic carcinoma was the commonest histological type (45.6%) and hard palate
Poster abstracts, Sunday 20 May was the commonest site. Locoregional recurrence was seen in 20.3% and distant metastasis in 13.9.% of patients. Median follow-up was 5.47 years and median disease free survival 12.6 years. 5 and 10-year disease free survival was 75% and 70% and 5 and 10-years over all survival was 80% and 90% respectively.Univariate analysis revealed sex, invasion of bone, lympho-vascular invasion, soft tissue invasion and histology type as significant predicators of survival. Multivariate analysis showed sex, invasion of bone, invasion of soft tissue, absence of postoperative adjuvant radiotherapy to be significantly associated with low disease free survival. Conclusion: These tumours have got preponderance for recurrence. Adenoid cystic carcinoma is the most common histologic type and has got preponderance for both recurrence and distant metastasis. Due to late recurrence long term follow up is mandatory. Keywords: minor salivary gland; intraoral, surgical excision; postoperative radiotherapy. P300 Alpha B-Crystallin (ABCrys) a novel biomarker in metastatic cutaneous squamous cell carcinoma of the head and neck K. Lim *, L. DaSilva, W. Coman. University of Queensland, Australia In Australia, incidence of cutaneous SCC is ~321 per 100,000 population. Due to predominant involvement of the head and neck and propensity for lymphatic spread, the most common malignancy involving the parotid gland in Australia is metastatic cutaneous cancer. Current literature has focussed on clinical parameters eg TNM and parotid disease staging, characteristics of the primary, treatment modalities etc. Prognostic biomarkers are described in “head and neck” SCC, but it has not been established that SCCs at different anatomical sites (eg skin, oral cavity, larynx, oesophagus, cervix) are comparable in terms of clinical behaviour and outcome. ABCrys is a member of the small heat shock proteins (sSHSP) family, molecular chaperones preventing aggregation of nascent and stress-accumulated misfolded proteins. It prevents activation of pro-caspase 3, increases microtubular resistance to depolymerization, and is involved in proteasomemediated degradation. Although a major lens protein, it is present in tissues with high oxidative capacity eg heart, skeletal muscle, kidney. ABCrys may participate in development of neuro-degenerative diseases and malignant tumors; it is over-expressed in glial tumors and renal carcinoma. Overexpression may limit efficacy of cancer therapy, presumably by reducing apoptosis. Expression of exogenous ABCrys prevents UVA-induced activation of RAF/MEK/ERK pathway, substantially abrogating UVA-induced apoptosis. In oral SCC, ABCrys was a powerful prognostic marker, independent of nodal status. Apoptosis resistance conferred by ABCrys may contribute to aggressive behavior in basal-like breast carcinomas. We investigated immunohistochemical expression of ABCrys (using two different antibodies) in 37 patients with metastatic cutaneous SCC to the parotid ± neck (33 male, 4 female; age range 35 92 years). Archival tissue sections from the primary lesion, parotid and cervical lymph nodes were examined. Minimum follow up period was five years. Variables associated with ABCrys expression and correlation with other biomarkers was analyzed using the c2 test. Differences were assessed by independent Wilcoxon method, survival rates estimated by Kaplan Meier method and compared using log-rank test. Multivariate survival analysis was performed using Cox proportional hazards model. ABCrys expression was localized to the cytoplasm, and observed in 19 cases with a variable proportion of positive tumor cells. Overexpression correlated with poor prognosis and reduced