Absence of Merkel cell polyomavirus in primary parotid high-grade neuroendocrine carcinomas regardless of cytokeratin 20 immunophenotype

High-grade neuroendocrine carcinoma of the salivary glands is a rare malignancy that can be difficult to distinguish from metastatic neuroendocrine (Merkel cell) carcinoma of the skin, which often occurs on the head and neck and may metastasize to lymph nodes in or adjacent to salivary glands, particularly the parotid gland. As the 2 tumors have morphologic and immunophenotypic overlap, additional diagnostic tools may be clinically useful. Merkel cell carcinoma is known to harbor Merkel cell polyomavirus in up to 80% of cases. However, the presence or absence of this virus in salivary gland neuroendocrine carcinomas has not been investigated. We evaluated 7 primary salivary gland high-grade neuroendocrine carcinomas (all from the parotid) for the virus by both immunohistochemistry (CM2B4 clone) and real-time polymerase chain reaction directed against the conserved small T antigen. Five of the tumors had small cell morphology, and 2 had large cell morphology. All were either chromogranin and/or synaptophysin positive. Four of the 5 small cell (80%) and 1 of the 2 large cell (50%) carcinomas were cytokeratin 20 positive. All but 1 case had cervical lymph node metastases at presentation. Merkel cell polyomavirus T antigen was not detected in any of the 7 tumors, either by immunohistochemistry or by polymerase chain reaction with adequate controls. These observations suggest that primary parotid high-grade neuroendocrine carcinoma arises from a biological pathway that is different from that of cutaneous Merkel cell carcinomas. Furthermore, viral testing may aid in distinguishing the 2 tumor types, as a positive result would favor a metastasis.     

High Rates of Ultraviolet-Signature Mutations in Squamous Cell Carcinomas of the Parotid Gland and Prognostic Implications

In the absence of clear pathologic differences, clinical history may differentiate potential primary parotid squamous cell carcinomas (SCC) from metastases. The presence of an ultraviolet (UV) signature can distinguish between tumors of cutaneous and non-cutaneous origin. This study aimed to investigate rates of UV signature mutations in squamous cell carcinomas of the parotid gland as well as differences in clinical features between tumors of cutaneous and non-cutaneous origin. Clinical and pathologic data were collected from 71 patients with SCC involving the parotid gland, of which 48 had cutaneous, 10 had mucosal, and 13 had no history of SCC. In 34 available cases, genomic DNA was isolated from formalin-fixed paraffin-embedded tissue specimens and sequenced using a targeted hybrid capture 1213 gene panel. Tumor mutational burden and COSMIC (Catalogue of Somatic Mutations in Cancer) mutational signatures were calculated. Most (74%) were UV-positive. Patients with UV-positive tumors were significantly older, white, and had higher rates of sun exposure. Patients with UV-negative tumors had a significantly higher mortality rate and shorter time to death: 6 (67%) died of disease with a median time to death of 9 months compared to 5 (20%) UV-positive patients who died of disease with a median time to death of 32 months. Pathologic features did not significantly vary by clinical history or UV status. The presence of a UV-signature combined with clinical history can be used to determine the primary source of SCC involving the parotid gland. UV-positivity may reflect a less aggressive disease course in an older population.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12105-021-01349-x.     

Squamous and basal cell cancers directly invading major salivary glands

Epidermoid carcinoma of the skin of the head and neck may uncommonly involve the parotid gland by either direct extension or metastases to the parotid lymph nodes. The parotid gland contains a rich network of superficial and deep nodes, draining a large area of the facial region, with the preauricular, cheek, ear, and eyelid dominating. Few patients with direct parenchymal invasion of the parotid gland by a simultaneously existing squamous or basal cell carcinoma were reported. We could find no report discussing direct tumoral invasion into the submandibular salivary gland. Three patients with squamous cell carcinomas and 2 with basal cell carcinomas of the skin directly involving the underlying salivary glands are presented. The few authors discussing this subject concur that treatment should include resection of the primary tumor along with parotidectomy. Elective neck dissection and irradiation are proposed. The course of disease, treatment, and survival of our patients are discussed.     

Carcinoma of the parotid gland

BACKGROUND: The low incidence and heterogeneity of histiotypes of primary parotid carcinomas makes these tumors histologically and epidemiologically difficult to evaluate. The present study reviews a single institution's experience in the treatment of primary parotid carcinomas during the last 10 years. METHODS: The charts of 98 consecutive patients who had a primary parotid carcinoma and who received primary curative treatment were analyzed retrospectively. The tumors were grouped into high-grade and low-grade malignancies. The effect of treatment modalities on locoregional control, the incidence of locoregional recurrences and distant metastases, and survival rates are evaluated and compared between high- and low-grade malignancies. RESULTS: High- and low-grade malignant tumors were observed in 50 and 48 cases, respectively. Lymph node metastases were detected in 25 of 98 (25%) patients, of whom 8 of 22 (22%) clinically NO staged patients underwent elective neck dissection. In 24 of 26 resected facial nerves, a histologic tumor infiltration was confirmed, in 14 high-grade and 10 low-grade tumors. Local recurrence developed in 13 patients and was associated in 7 with high-grade and in 6 with low-grade tumors. All but 1 of the low-grade malignancies with local recurrence did not receive postoperative irradiation. Regional recurrence developed in 11 patients and distant metastases developed in 10, 3 in combination with a neck recurrence and 1 with a local recurrence. The survival rate at 5 years for low- and high-grade carcinomas was 87% and 56% and the disease-free survival rate 72% and 48%, respectively. CONCLUSIONS: The incidence of occult metastases in clinically N0-elective neck dissection was 22%. A routine elective neck dissection in all N0 parotid carcinomas is suggested. There is no statistically significant difference between low- and high-grade tumors as for the rate of local recurrence and, as all except one of the low-grade malignancies with local recurrence did not receive postoperative irradiation, postoperative irradiation is not only suggested for high-grade carcinomas but also for T2 to T4 low-grade carcinomas.     

Testicular seminoma metastasizing to the parotid gland: report of a case

BACKGROUND: Among salivary glands, the parotid gland is the most common site for secondary neoplastic involvement, and carcinomas and melanomas are the two most common secondary tumors. METHODS: We present a case of testicular seminoma metastasizing to the parotid gland. The patient, who had a remote history of testicular seminoma, was initially seen with a parotid mass. A primary parotid lesion was anticipated, and excisional biopsy was performed. The diagnosis of testicular seminoma metastasizing to the parotid gland was established on the basis of histologic findings and was confirmed by immunohistochemical analysis. RESULTS: Metastatic and primary seminomas have the same morphologic features and cellular composition, and granulomatous reaction is often present in both neoplasms. Extragonadal seminoma often occurs in the midline (presacral, retroperitoneal, anterior mediastinal, and pineal regions); when present in any other locations, the tumor should be considered to be metastatic. Placenta alkaline phosphatase is a useful immunohistochemical stain to confirm the diagnosis, and cytokeratin immunohistonegativity rules out carcinomas or epithelioid sarcomas. CONCLUSIONS: To our knowledge, this is the first published case of metastatic testicular seminoma to the parotid gland. Cytomorphologic features of seminoma and the presence of granulomatous giant cells are important diagnostic clues. Two other neoplasms with granulomatous reactions, nasopharyngeal carcinoma and epithelioid sarcoma, should be considered in the differential diagnosis.     

Mucoepidermoid/Adenosquamous Carcinoma of the Skin: Presentation of Two Cases

BACKGROUND: Mucoepidermoid carcinoma is a relatively common neoplasm of the major and minor salivary glands comprising 10-30% of primary carcinomas. They may involve the skin through direct extension, metastases, and rarely, as a primary focus (adenosquamous carcinoma). OBJECTIVE: To discuss through case reports, the nomenclature, histology, clinical course, and treatment of mucoepidermoid/adenosquamous carcinoma. METHODS: We present a case of mucoepidermoid carcinoma primary to an upper eyelid accessory lacrimal gland with direct cutaneous extension and a case of primary cutaneous adenosquamous carcinoma of the scalp. RESULTS: An eyelid neoplasm of lacrimal origin was initially treated with Mohs micrographic surgery (MMS), requiring an orbital exenteration to achieve a tumor-free plane. In the second case, a primary scalp lesion was cleared with MMS. Neither patient has had local recurrence or metastases. CONCLUSION: Correct diagnosis is crucial to pursuing adequate treatment for this aggressive neoplasm. We support the use of MMS to achieve local control.     

Sebaceous epithelial-myoepithelial carcinoma of the salivary gland: clinicopathologic and immunohistochemical analysis of 6 cases of a new histologic variant

Epithelial-myoepithelial carcinoma (EMC) of the salivary glands is an uncommon, low-grade malignant tumor. A recent report demonstrates sebaceous differentiation in this tumor even though its significance has never been documented as a precise histologic variant. Six cases of EMC exhibiting sebaceous differentiation (sebaceous EMC) of the parotid gland were analyzed for their clinicopathologic features and immunohistochemical characteristics. In addition, primary salivary sebaceous carcinomas were also examined for comparison. In our series, the incidence of sebaceous EMC was 0.2% among 3012 cases of parotid gland tumors and 14.3% of all EMC cases. The 6 patients comprised 2 men and 4 women, age ranging from 77 to 93 years (mean, 83.7 y). Neither cervical lymph node nor distant organ metastases were found in any cases of sebaceous EMC and no patients died of disease, though local recurrences developed in 1 patient. Conversely, cervical lymph node metastasis was detected in 2 of 3 patients with sebaceous carcinoma, 1 of whom died of disease at 12 months. Histologically, all 6 tumors had an area of sebaceous differentiation admixed with features of bilayered ductal structures typical of EMC. A component of sebaceous differentiation was distributed diffusely in 4 tumors and focally in 2. Cytologic atypia of sebaceous EMCs was lesser than that of sebaceous carcinomas. Immunohistochemically, putative myoepithelial markers such as alpha-smooth muscle actin, calponin, p63, cytokeratin 14, S-100 protein, and vimentin were highly expressed in sebaceous EMC. However, the expression of the latter 4 markers was also observed in primary sebaceous carcinomas, whereas these tumors were all negative for alpha-smooth muscle actin and calponin. Positive immunoreactivity for epithelial membrane antigen, adipophilin, and perilipin confirmed sebaceous differentiation in EMC. These results indicate that sebaceous EMC is a low-grade malignancy, similar to conventional EMC. Our data also suggest that immunohistochemical examination of specific myoepithelial markers is helpful in distinguishing sebaceous EMC from sebaceous carcinoma, which may occasionally be associated with an aggressive clinical course.     

Clinical characteristics and survival for major salivary gland malignancies in children.

OBJECTIVE: Determine presentation and survival rates for malignant pediatric salivary gland neoplasms. METHODS: All cases of malignant neoplasms involving the parotid or submandibular gland in patients ages birth to 18 years were extracted from the Surveillance, Epidemiology, and End Results database (1988-2001). Variables included age, gender, tumor histology, size, follow-up time, and vital status. Kaplan-Meier survival curves were constructed. RESULTS: 113 primary salivary gland malignancies (103 parotid, 10 submandibular) were identified. Mean age at presentation was 13.2 years. Female:male ratio of 5:4. Mean tumor size was 2.5 cm. Among parotid tumors, there were 44 (43%) mucoepidermoid carcinomas and 35 (34%) acinic cell carcinomas. At a mean follow-up of 69.4 months, 6 (5.8%) patients with parotid malignancy were deceased; none of the submandibular malignancies were fatal. Mean Kaplan-Meier survival for parotid gland lesions was 153 months, with rhabdomyosarcomas exhibiting significantly worse survivals as compared to other malignancies (P < 0.001, log-rank test). CONCLUSIONS: Both epithelial and mesenchymal tumors present in the pediatric salivary gland. Survival for both parotid and submandibular gland malignancies is good in children. EBM rating: C-4.     

Surgical procedures for primary, metastatic or adjacent parotid tumours

OBJECTIVE: The retrospective analysis of the surgical procedures in primary parotid and metastatic or adjacent parotid tumors. PATIENTS AND METHODS: Retrospective review of the records of 145 patients operated on for primary, metastatic or adjacent parotid tumors revealed 85 patients with benign tumors, 24 with primary malignant tumors, 19 with squamous skin carcinomas, 12 with skin melanomas, 3 with basocellular carcinomas and 2 with sarcomas of the parotid region. The analysis included the type of parotidectomy, the need for facial nerve sacrifice (FNS), type of neck dissection and soft part reconstruction. RESULTS: Superficial parotidectomy was performed in 81% of the benign parotid tumors and 100% of skin melanomas. Total parotidectomy was frequent in malignant parotid tumors (62%), epidermoid skin tumors (64%) and in basocellular/sarcomas of the parotid region (80%). Skin graft or flaps was infrequent in primary malignant tumors (12.5%), and frequent in epidermoid skin tumors (74%), melanomas (58%) and basocellular/sarcomas (100%). FNS was necessary in primary malignant (25%), adjacent epidermoid (37%), melanomas (17%) and basocellular/sarcomas (80%). Details on neck dissections are provided. CONCLUSIONS: Superficial parotidectomy was an adequate procedure for most benign parotid tumors and for melanoma patients. In primary malignant and adjacent or metastatic skin tumors, total parotidectomy, neck dissection and soft part reconstruction were frequent procedures. FNS and soft part reconstruction should be anticipated more frequently in squamous/basocellular skin tumors or sarcomas adjacent to the parotid gland.     

Salivary tumors in north Jordanians: a descriptive study.

OBJECTIVE: To evaluate the types and distribution of tumors of salivary glands in north Jordanians. STUDY DESIGN: The records of the Department of Pathology at Jordan University of Science and Technology were reviewed for patients who were treated for salivary gland tumors from 1991 to 2002. The tumors were analyzed for age of patient, sex of patient, tumor site, and tumor type. RESULTS: One hundred two true neoplasms (70% benign and 30% malignant) were found. The most frequent benign and malignant neoplasms found were pleomorphic adenoma (54%) and adenoid cystic carcinoma (13%), respectively. The most common major and minor salivary gland sites were the parotid (51%) and palatal glands (20%), respectively. Although most of major gland tumors were adenomas, carcinomas of the minor glands were only slightly less frequent than adenomas. The most frequent malignant parotid tumors were adenoid cystic carcinoma and mucoepidermoid carcinoma. The most frequent minor salivary gland malignant tumors were palatal adenoid cystic carcinoma. Age ranged from 1 to 94 (mean 40) years, with a male to female ratio of 1:1.2. CONCLUSION: North Jordanians with salivary gland tumors were found to have similar characteristics with patients of other countries with regard to tumor type, tumor site distribution, and age and sex of patients.     

Parotid tumors in children.

Most salivary gland tumors, both benign and malignant, develop within the parotid glands. Although an overwhelming majority of tumors are reported in the adult population, the parotid glands are also the most frequently involved salivary glands in the pediatric age group. This study represents a combination of case material from the Armed Forces Institute of Pathology and our personal experiences. Of approximately 10,000 salivary gland lesions accessioned in all ages, only 124 tumors occurred in the parotid gland in children less than fifteen years old. There were ninety benign and thirty-four malignant lesions. The two most common benign masses were mixed tumors and vascular lesions. The most common malignancies were the mucoepidermoid and acinic cell carcinomas. We recommended that all solid tumors be removed by parotidectomy.     

Irradiation induced salivary gland neoplasia.

Twenty-six patients with a prior history of irradiation for benign conditions of the head and neck and salivary gland abnormalities are reported. All the patients had preoperative physical findings suggestive of tumor, not glandular infection. Forty-six per cent of the patients had one carcinoma and 11% had two carcinomas within the irradiated field. Eight of the 11 malignant tumors in these 26 patients were in the parotid gland. The nonmalignant salivery changes were similar to those previously reported in glands receiving therapeutic irradiation for carcinoma.     

Primary thymic carcinomas

Within a 75-year period, 20 patients with primary nonteratomatous carcinomas of the thymus were seen at the Mayo Clinic. Fourteen were males and six were females, with a mean age of 48 years. Thirteen of the lesions were classified as poorly differentiated or spindling squamous cell carcinomas. One neoplasm was a sarcomatoid carcinoma, and two showed both squamous cell and neuroendocrine ultrastructural features. The remaining four tumors had both light- and electron-microscopic features of neuroendocrine carcinomas. In all 20 patients, careful clinical and pathologic examinations, including autopsy in fatal cases, excluded malignant lymphomas and metastasis to the thymus from epithelial tumors in other anatomic sites. Thirteen patients underwent surgery, with or without postoperative radiotherapy; of these, one was alive and apparently disease-free 43 months after diagnosis. There were two operative deaths. The remaining patients received primary radiotherapy or chemotherapy, or both. The mean survival of the 16 patients who died (excluding operative deaths) was 18.7 months for the 14 patients with tumors of squamous cell differentiation and 36.0 months for the two patients with pure neuroendocrine carcinomas. Among patients with squamous cell carcinoma, 11 developed metastases to lungs, liver, bones, adrenal glands, or extrathoracic lymph nodes; nine of these died of massive local growth within the mediastinum. Among patients with neuroendocrine carcinomas, two of four patients died of local growth within the mediastinum; one of these also had metastases to the liver and adrenal glands. One patient with oat cell carcinoma was alive with residual thoracic tumor and cervical lymph node metastasis 18 months after diagnosis.     

Lacrimal and salivary gland inflammation in the C3H/Ipr autoimmune strain mouse: a potential mode for Sj?gren's syndrome.

Sj?gren's syndrome is an autoimmune inflammatory disease that affects the lacrimal and salivary glands. To identify a potential animal model for study of Sj?gren's syndrome, an evaluation was made of lacrimal and salivary glands in the C3H/Ipr autoimmune strain mouse at ages before (2 months) and after (5 months) systemic autoimmune disease onset at 3 to 4 months. Quantitative and qualitative analyses of C3H/Ipr lacrimal and salivary (parotid, submandibular, and sublingual) gland histopathology were performed using age-matched C3H/HeJ nonautoimmune mice to control for inflammation of nonautoimmune origin. No lacrimal or salivary gland inflammation was seen in either of the strains at 2 months of age and measures of systemic autoimmune disease were negative. At 5 months of age, the nonautoimmune C3H/HeJ controls showed a slight increase in lacrimal gland inflammation, but this was not significantly different from the 2 month old controls. A significant increase in lacrimal gland inflammation was found in the 5 month old C3H/Ipr autoimmune mice in a histologic pattern similar to that of Sj?gren's syndrome in human beings. Furthermore, the degree of inflammation was positively correlated with serum immune complexes and spleen weight. Sporadic inflammation of the submandibular gland was seen in both autoimmune and control mice, but this was neither statistically significant nor correlated with measures of autoimmunity. No significant inflammation was seen in the parotid or sublingual glands.     

Multiple Malignant Salivary Gland Neoplasms: Mucoepidermoid Carcinoma of Palate and Adenoid Cystic Carcinoma of Floor of Mouth

Salivary gland tumors usually occur as single lesions. To have more than one tumor is unusual. We report a case of an adult male who presented with a mucoepidermoid carcinoma involving the minor salivary glands of the palate at age 57 years, followed by an adenoid cystic carcinoma of the floor of mouth at age 63 years. The patient later succumbed to non-Hodgkin lymphoma at age 72 years. There are 31 acceptable cases of multiple malignant salivary gland neoplasms reported in the world literature. Multiple malignant tumors of the same histologic type are more common than those of different histologic type. Bilateral acinic cell adenocarcinoma was the most frequent combination of multiple salivary gland malignancy, accounting for 14 cases (10 synchronous and four metachronous). All involved the parotid glands bilaterally with the exception of one case that involved parotid and submandibular gland. Polymorphous low-grade adenocarcinoma accounted for three of the four cases of multiple malignant tumors involving minor salivary glands. Individuals with a history of malignancy are at risk for the development of additional malignant tumors and should receive appropriate clinical follow-up.

肾癌根治术中切除肾上腺的适应证

目的:探讨行肾癌根治术时切除肾上腺的适应证.方法:对484例患者行肾癌根治术中,213例同时切除同侧肾上腺,2例切除对侧肾上腺,1例切除双侧肾上腺;270例保留同侧肾上腺.结果:216例切除肾上腺经病理检查,11例(5.1%)发现有肾上腺转移,4例肾上腺良性病变.11例转移病例中8例术前CT(MRI)提示有肾上腺转移,肾卜腺转移患者的肿瘤直径均值>8 cm;1例为T1期肿瘤,6例为T3期肿瘤,4例为T4期肿瘤.268例保留肾上腺组中,1例于术后14个月发现同侧肾上腺肿瘤转移,1例于术后28个月发现双侧肾上腺转移.结论:CT是肾癌术前诊断及术后随访的重要影像诊断方法;保留同侧肾上腺手术仅在肿瘤局限于肾内且直径≤4 cm才是安全的;怀疑对侧肾上腺有肿块时,均应手术探查.孤立的肾上腺转移,是肾上腺转移瘤切除术的适应证.     

Epithelial tumors of the lacrimal gland: Clinico-pathologic correlation and management

Between 1960 and 1987 29 patients underwent surgery at the Munich University Eye Hospital for benign and malignant tumors of the lacrimal gland. Fifteen tumors were classified as pleomorphic adenomas (three of them with malignant transformation), nine as adenoid cystic carcinomas, two as adenocarcinomas, two as oxyphilic adenomas, and one as oxyphilic adenocarcinoma. The clinico-pathologic correlation of these tumors is described. All age groups were involved in both benign and malignant epithelial gland tumors. A fast growing lesion with bone destruction of the lacrimal fossa in association with pain was found to be highly suspicious of a malignant epithelial tumor. Prior to surgery, inflammatory lesions and lymphomas should be ruled out by clinical history, examination, diagnostic imaging techniques, and, occasionally, by a short course of oral corticosteroids. A diagnostic biopsy prior to tumor excision and a transfrontal surgical approach via craniotomy has a negative impact on the prognosis. Thus it is mandatory to remove epithelial lacrimal gland tumors completely at the time of the initial surgical procedure. Craniotomies facilitate recurrences of lacrimal gland tumors by infiltration into the central nervous system. Lateral orbitotomies using the Krönlein technique are the best surgical approach for successful removal of these unusual tumors.     

Metastases of Cutaneous Squamous Cell Carcinoma Seem to be the Most Frequent Malignancies in the Parotid Gland: A Hospital-Based Study From a Salivary Gland Center

Malignant parotid tumors account for approximately 20% of all parotid lesions. In addition to the various primary parotid lesions there are secondary parotid malignancies, such as metastases or lymphomas. Data on histopathological distribution of all malignancies—including secondary parotid lesions—is limited. Recent evidence indicated a rising surgical incidence of secondary parotid malignancies. This study aims to review the distribution of malignancies in parotid resections from a salivary gland center. A retrospective review of prospectively collected data for all patients who had received parotidectomy between 2014 and 2019 was performed. Histopathological distribution was displayed separately for all parotid malignancies and for primary parotid malignancies. Further, patients` characteristics were compared between benign and malignant parotid lesions and between the two most common malignant parotid lesions. Out of 777 patients, 614 (78.9%) patients had a benign and 164 (21.1%) patients had a malignant parotid lesion. The most common parotid malignancy was metastatic cutaneous squamous cell carcinoma (cSCC) accounting for 35.4% of all parotid malignancies. 71.5% of all malignant lesions were secondary malignancies. Patients with metastatic cSCC were significantly older (p < 0.001) and significantly more likely to be male (p < 0.001) than patients with primary parotid malignancies. No significant difference was found when the lesion size of metastatic cSCC was compared to primary parotid malignancies (p = 0.216). The present study shows the high prevalence of secondary parotid malignancies in patients who had received parotidectomy. Furthermore, it confirms a rising surgical incidence of metastatic cSCC to the parotid gland in a series from a salivary gland center. At this time, parotid surgery for malignant lesions is more likely to be performed for metastases than for primary parotid malignancies.     

Adrenal metastases of Ewing's sarcoma. Report of one case

Adrenal metastases are more frequent than primary adrenal carcinoma. The most frequent are, in this order: breast and lung cancer, stomach and kidney carcinomas, adrenal gland contralateral tumors and melanoma. Less frequent are tumours of the bladder, colon, esophagus, gall bladder, liver, pancreas, prostate, stomach and uterus. The rest of the tumours rarely spread toward adrenal glands. The metastases to the adrenal glands caused by sarcomas are rare and normally they happen in the contest of a massive metastases affecting several organs at the same time. We present a case of a patient affected by adrenal metastases of Ewing's sarcoma who has been referred to us for surgical treatment because it is a unique metastases (there is no sing of more illnesses in other organs at the time of the exploration).     

Pattern of regional metastases from cutaneous squamous cell carcinoma of the head and neck

OBJECTIVE: To assess the pattern of regional metastases from SCC of the skin of the head and neck as a prognostic factor. STUDY DESIGN AND SETTING: A retrospective chart review of 22 patients treated in a tertiary academic center. RESULTS: Metastases could be assessed clinically in the parotid gland and the neck in 50% and 59% of the patients, respectively. Histologic examination showed metastases in the parotid gland and the neck in 68% and 45.5%, respectively. Occult disease was 36% and 20% in the parotid gland and neck, respectively. The 1st echelon for metastasis was the parotid gland lymph nodes, whereas level II lymph nodes were the 1st echelon in the neck. Metastases to both the parotid gland and neck decreased the overall survival to 0, compared with 60% for metastases to the parotid gland and 100% for the neck. CONCLUSIONS: SCC of the skin of the head and neck with regional metastases has a high incidence of occult metastases in the parotid gland and the neck. Patients with metastases in both sites have a poor prognosis.