Tongue base mucosectomy identified cancer in 78 per cent of cancers of unknown primary in a recent meta-analysis. The carbon dioxide laser is an alternative technique if there is no access to a robot. This study aimed to describe the steps for undertaking tongue base mucosectomy using the carbon dioxide laser and its diagnostic utility in cancers of unknown primary.

This was a prospective feasibility study utilising carbon dioxide laser for tongue base mucosectomy in cancers of unknown primary. Data collected included demographic data and p16 status.

There were 14 cancers of unknown primary with 86 per cent p16 positivity on immunohistochemistry. Laser tongue base mucosectomy alone identified the cancer primary in 7 of 12 (58 per cent) cancers of unknown primary among p16 positive tumours and 0 of 2 (0 per cent) among p16 negative tumours. Combining bilateral tonsillectomy with laser tongue base mucosectomy resulted in identification of the primary cancer in 8 of 12 (67 per cent) p16 positive tumours.

In centres without a robot, tongue base mucosectomy using the carbon dioxide laser is a viable alternative, especially in combination with bilateral tonsillectomy in p16 positive cases.

Cervical metastasis from an unknown primary site invariably results in pan-mucosal irradiation if a primary tumour is not identified. Transoral robotic and laser-assisted mucosectomy are valid techniques to increase diagnostic rates, but these remain restricted to certain centres. This paper describes, in detail, a technique in which mucosectomy is performed via endoscopic electrocautery.

Patients were prospectively recruited between May 2017 and June 2018. Inclusion criteria stipulated biopsy-proven metastatic cervical squamous cell carcinoma, with negative findings on magnetic resonance imaging and positron emission tomography/computed tomography, in addition to examination under anaesthetic, tonsillectomy and ‘blind’ tongue base biopsies without tumour identification, prior to mucosectomy.

Of nine patients, a mucosal primary was identified in four (44.4 per cent), for which ipsilateral intensity-modulated radiotherapy was advocated in three and completion tongue base resection in the fourth. Dysplasia was demonstrated in two further patients, which provided information relevant to radiotherapy fields and post-treatment surveillance. No surgical complications were identified.

Tongue base mucosectomy using electrocautery and conventional tonsillectomy equipment is a safe, effective technique in the identification of cervical metastasis from an unknown primary site. It expands the potential breadth of use, quickens prolonged diagnostic pathways and obviates the necessity for pan-mucosal irradiation.

Adenosquamous carcinoma is a rare variant of semicircular canal that can affect various regions, including the head and neck. Adenosquamous carcinoma is characterised pathologically by the simultaneous presence of distinct areas of semicircular canal and adenocarcinoma, and usually takes an aggressive course with local recurrences, early lymph node metastases and distant disseminations.

We report a rare case of neck adenosquamous carcinoma of unknown primary origin, which was well-controlled by thorough resection without any other additional therapy.

We discuss the diagnosis and treatment of adenosquamous carcinoma along with a review of pertinent literature. We also consider the potential differential diagnosis of branchiogenic carcinoma.

Follow-up surveillance of head and neck cancer patients varies throughout the UK. The heterogeneity of these patients limits the applicability of a standardised protocol. Improvements in our understanding of the natural history of the disease may assist in the tailoring of resources to patients.

Prospective data collected at the Cumberland Infirmary over a 13-year period were analysed, primarily focusing upon recurrence rates and time to recurrence.

In keeping with other studies, recurrence of head and neck squamous cell carcinoma was found to be maximal within the first three years of treatment, regardless of subsite.

Hospital-based surveillance may be safely discontinued after three years for some patients. Laryngeal carcinoma may require further surveillance due to possible delayed recurrence of a second primary formation. Emphasis must be placed on patient education, accessibility to head and neck services, and the existence of a robust system to facilitate urgent referrals.