Background: For patients with head and neck squamous cell carcinoma (HNSCC), after a single or multi-modality treatment, a specific follow-up strategy is needed, but there is no agreement between the main international societies on the proper methods and timing of follow-up. Methods: We performed a descriptive review to evaluate the available data and compare the main guidelines, giving some practical guidance to perform effective personalized follow-up strategies. Results and Conclusions: While clinical and endoscopic follow-up alone seems to be appropriate for early-stage HNSCCs, the addition of close radiologic follow-up in locally advanced HNSCCs is still debated, as there are no data indicating that an earlier detection of recurrence correlates with increased survival, while it is mandatory in the first three-six months to define the response to treatment. For patients who have undergone conservative surgery or have major pathological risk factors, the incidence of locoregional recurrence is higher, and locoregional radiologic follow-up (magnetic resonance imaging is preferred to computed tomography) should be considered. Positron emission tomography may be useful in cases of suspected locoregional persistence of disease, differentiating it from post-irradiation outcomes. Distant radiological follow-up can be considered in the detection of the second primary in cases of specific risk factors and for virus-related tumors. For the latter, the use of circulating DNA should always be considered. A brain scan is not recommended without specific symptoms. For all patients who do not fall into the above categories, clinical and endoscopic follow-up should be proposed, reserving radiological investigations only at the onset of symptoms.

A recent study reported that the occurrence of depapillated mucosa surrounding oral tongue squamous cell carcinomas (OTSCC) is associated with perineural invasion (PNI). The present study evaluates the reliability of depapillation as a PNI predictor and how it could affect narrow-band imaging (NBI) performance. This is thus a retrospective study on patients affected by OTSCC submitted to radical surgery. The preoperative endoscopy was evaluated to identify the presence of depapillation. Differences in distribution between depapillation and clinicopathological variables were analyzed. NBI vascular patterns were reported, and the impact of depapillation on those was studied. We enrolled seventy-six patients. After evaluation of the preoperative endoscopies, 40 (53%) patients had peritumoral depapillation, while 59 (78%) had a positive NBI pattern. Depapillation was strongly correlated to PNI, 54% vs. 28% (p = 0.022). Regarding the NBI pattern, there was no particular association with depapillation-associated tumors. The presence of depapillation did not affect the intralesional pattern detected by the NBI, while no NBI-positive pattern was found in the depapillation area. Finally, the NBI-guided resection margins were not affected by depapillation. Peritumoral depapillation is a reliable feature for PNI in OTSCC. NBI margin detection is not impaired by depapillation.

Background/Objectives: The role of induction chemotherapy (IC) in advanced oral cavity squamous cell carcinoma (OCSCC) remains controversial. This study evaluated patient-level changes in primary-tumour and cervical nodal dimensions, subsequent definitive treatment, and survival after curative-intent IC. Methods: We retrospectively analysed 38 patients with primary, non-metastatic OCSCC treated with curative-intent IC between 2009 and 2024. Recurrent disease, second primary tumours, non-squamous histology, non-oral primary sites, baseline metastatic disease, direct chemoradiotherapy, and palliative systemic treatment were excluded. A prespecified simplified unidimensional radiological analysis was performed. The maximum axial primary-tumour diameter, the largest baseline cervical node, and total recorded nodal burden were compared before and after IC. Baseline nodes absent after IC were coded as 0 mm only when disappearance was confirmed on post-IC anatomical imaging. The overall survival (OS) was measured from IC initiation. Results: Primary-tumour measurements were evaluable in 25 patients. Median diameter decreased from 55.0 to 46.0 mm, corresponding to a median change of −13.5% (p = 0.049). The largest baseline node was evaluable in 19 patients and decreased from 17.0 to 13.0 mm, a median change of −16.7% (p = 0.004). Total nodal burden changed by a median of −8.3% (p = 0.257). Primary-tumour change did not differ significantly from largest-node change (p = 0.073) or total nodal-burden change (p = 0.860). TP and TPF showed no difference in primary-tumour change (p = 0.954). During a median follow-up of 40.4 months, 16 patients died. Median OS was 45.1 months and 5-year OS was 35.6%. Conclusions: IC produced heterogeneous, generally modest radiological changes. The largest baseline node decreased significantly, whereas total nodal burden did not. These data do not establish the superiority of one regimen or a causal survival benefit from surgery and should be considered hypothesis-generating.