Parotid area lymph node metastases from cutaneous squamous cell carcinoma: implications for diagnosis, treatment, and prognosis

BACKGROUND: Parotid area lymph node metastasis from primary scalp and facial cutaneous cancers is a poorly recognized clinical entity partly because of the long time lapse between the index lesion and regional spread. METHODS: A retrospective review of the University of Wisconsin Tumor Registry and Head and Neck Oncology Tumor Board was performed over a 10-year period from 1989 to 1999. One hundred two patients with a malignant parotid mass were identified. Of these, 20 patients were identified with parotid region squamous cell carcinoma and prior index skin cancer of the face or scalp. These patients were analyzed regarding presentation, diagnostic evaluation, interval between index lesion and metastasis, treatment method, and long-term outcome. RESULTS: Approximately 20% of patients (20 of 102) in this series with a malignant parotid mass had presumed metastasis from an identifiable skin primary tumor. The mean time from index lesion to presentation of regional spread was 13.5 months. Seventy percent of the patients (14 of 20) underwent surgery followed by radiation as locoregional therapy, whereas 30% underwent surgery alone. Six (30%) of 20 patients required some degree of facial nerve sacrifice. Three patients (15%) experienced subsequent locoregional failure. Two of six patients from the surgery alone group and one of 14 patients who received surgery plus radiation therapy experienced locoregional relapse. CONCLUSIONS: Parotid area lymph node metastases from scalp and facial cutaneous carcinomas require aggressive therapy to optimize locoregional control. The addition of radiotherapy after parotidectomy is important and should be considered for optimal disease control. Selective neck dissection or radiation may be warranted at the time of parotidectomy. This combined approach is associated with high locoregional control rates and is generally well tolerated.