Cutaneous squamous cell carcinomas (cSCC) are malignant tumours with excellent prognosis unless nodal metastases develop. The aim of our study is to determine the prognostic significance of the clinical stage of parotid gland metastases and the incidence of occult cervical lymph node involvement in cSCC of the head. Our retrospective analysis includes 39 patients with cSCC parotid gland metastases, 15 of whom had concurrent cervical node involvement. In 32 patients, the lymph nodes manifested at stage N3b. A total of 26 patients were treated with parotidectomy, 9 patients received radiotherapy alone, and 4 received symptomatic therapy. The surgical treatment included either total conservative (21 cases) or superficial parotidectomy (5 cases) and neck dissection (therapeutic neck dissections in 11 cases and elective in 14 cases). In all cases, surgery was performed with sufficient tumour-free resection margins. Adjuvant radiotherapy was administered postoperatively in 16 patients. Occult metastases were present in 21% of cases after an elective neck dissection, but not in any case in the deep lobe of the parotid gland. The five-year overall survival and recurrence-free interval were 52% and 55%, respectively. Patients with the cN3b stage and G3 histological grade tend to have a worse prognosis, but not at a statistically significant level. The prognosis was not worse in patients with concurrent parotid and cervical metastases compared to those with metastases limited to the parotid gland only. The addition of adjuvant irradiation, in comparison to a single modality surgical treatment, was the only statistically significant prognostic factor that reduced the risk of death from this diagnosis (p=0.013). The extent of parotidectomy (partial vs. total) had no impact on either the risk of recurrence or patient prognosis. The combination of surgery with irradiation provides the best results and should be applied to all patients who tolerate the treatment. A partial superficial parotidectomy should be sufficient, with a minimum risk of occult metastasis in the deep lobe. Conversely, the relatively high incidence of occult neck metastases indicates that patients could likely benefit from elective neck dissection.

Department of Medical Biophysics Faculty of Medicine and Dentistry Palacky University Hnevotinska 3 77515 Olomouc Czech Republic

Department of Otorhinolaryngology and Head and Neck Surgery University Hospital Olomouc Faculty of Medicine and Dentistry Palacky University Olomouc Zdravotniku 248 7 Olomouc 77900 Czech Republic

Zobrazit více v PubMed

Franzen A., Lieder A., Guenzel T., Buchali A. The heterogenicity of parotid gland squamous cell carcinoma: a study of 49 patients. In Vivo . 2019;33:2001–2006. doi: 10.21873/invivo.11696. PubMed DOI PMC

Boukheris H., Curtis R. E., Land C. E., Dores G. M. Incidence of carcinoma of the major salivary glands according to the WHO classification, 1992 to 2006: a population-based study in the United States. Cancer Epidemiology, Biomarkers and Prevention . 2009;18(11):2899–2906. doi: 10.1158/1055-9965.EPI-09-0638. PubMed DOI PMC

NCCN Guidelines. NCCN Guidelines. 2023. https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1437 .

Akhtar K., Ray P. S., Sherwani R., Siddiqui S. Primary squamous cell carcinoma of the parotid gland: a rare entity. Case Reports . 2013;2013 doi: 10.1136/bcr-2013-009467. PubMed DOI PMC

Ying Y. L., Johnson J. T., Myers E. N. Squamous cell carcinoma of the parotid gland. Head and Neck . 2006;28(7):626–632. doi: 10.1002/hed.20360. PubMed DOI

Seifert G., Hennings K., Caselitz J. Metastatic tumors to the parotid and submandibular glands. Pathology, Research and Practice . 1986;181(6):684–692. doi: 10.1016/S0344-0338(86)80044-9. PubMed DOI

Brougham N. D., Dennett E. R., Cameron R., Tan S. T. The incidence of metastasis from cutaneous squamous cell carcinoma and the impact of its risk factors. Journal of Surgical Oncology . 2012;106(7):811–815. doi: 10.1002/jso.23155. PubMed DOI

Wermker K., Kluwig J., Schipmann S., Klein M., Schulze H. J., Hallermann C. Prediction score for lymph node metastasis from cutaneous squamous cell carcinoma of the external ear. European Journal of Surgical Oncology . 2015;41(1):128–135. doi: 10.1016/j.ejso.2014.07.039. PubMed DOI

Mourouzis C., Boynton A., Grant J., et al. Cutaneous head and neck SCCs and risk of nodal metastasis-UK experience. Journal of Cranio-Maxillofacial Surgery . 2009;37(8):443–447. doi: 10.1016/j.jcms.2009.07.007. PubMed DOI

O’Hara J., Ferlito A., Takes R. P., et al. Cutaneous squamous cell carcinoma of the head and neck metastasizing to the parotid gland--a review of current recommendations. Head and Neck . 2011;33(12):1789–1795. doi: 10.1002/hed.21583. PubMed DOI

O’Brien C. J., McNeil E. B., McMahon J. D., Pathak I., Lauer C. S., Jackson M. A. Significance of clinical stage, extent of surgery, and pathologic findings in metastatic cutaneous squamous carcinoma of the parotid gland. Head and Neck . 2002;24(5):417–422. doi: 10.1002/hed.10063. PubMed DOI

Gurudutt V. V., Genden E. M. Cutaneous squamous cell carcinoma of the head and neck. Journal of Skin Cancer . 2011;2011:10. doi: 10.1155/2011/502723.502723 PubMed DOI PMC

Aboziada M. A., Eisbruch A. Parotid squamous cell carcinoma: is it a primary or secondary? Journal of Clinical Oncology . 2011;29(15_suppl):p. e16002. doi: 10.1200/jco.2011.29.15_suppl.e16002. DOI

Chen M. M., Roman S. A., Sosa J. A., Judson B. L. Prognostic factors for squamous cell cancer of the parotid gland: an analysis of 2104 patients. Head and Neck . 2015;37:1–7. doi: 10.1002/hed.23566. PubMed DOI

Ch’ng S., Maitra A., Allison R. S., et al. Parotid and cervical nodal status predict prognosis for patients with head and neck metastatic cutaneous squamous cell carcinoma. Journal of Surgical Oncology . 2008;98(2):101–105. doi: 10.1002/jso.21092. PubMed DOI

Hinerman R. W., Indelicato D. J., Amdur R. J., et al. Cutaneous squamous cell carcinoma metastatic to parotid-area lymph nodes. The Laryngoscope . 2008;118(11):1989–1996. doi: 10.1097/MLG.0b013e318180642b. PubMed DOI

Lee S., Kim G. E., Park C. S., et al. Primary squamous cell carcinoma of the parotid gland. American Journal of Otolaryngology . 2001;22:400–406. doi: 10.1053/ajot.2001.28068. PubMed DOI

Dür C., Salmina C., Borner U., Giger R., Nisa L. Relevance of intraparotid metastases in head and neck skin squamous cell carcinoma. The Laryngoscope . 2021;131(4):788–793. doi: 10.1002/lary.28985. PubMed DOI

Thom J. J., Moore E. J., Price D. L., Kasperbauer J. L., Starkman S. J., Olsen K. D. The role of total parotidectomy for metastatic cutaneous squamous cell carcinoma and malignant melanoma. Journal of the American Medical Association Otolaryngol Head Neck Surg . 2014;140(6):548–554. doi: 10.1001/jamaoto.2014.352. PubMed DOI

Veness M. J., Porceddu S., Palme C. E., Morgan G. J. Cutaneous head and neck squamous cell carcinoma metastatic to parotid and cervical lymph nodes. Head and Neck . 2007;29(7):621–631. doi: 10.1002/hed.20576. PubMed DOI

Chen A. M., Grekin R. C., Garcia J., Bucci M. K., Margolis L. W. Radiation therapy for cutaneous squamous cell carcinoma involving the parotid area lymph nodes: dose and volume considerations. ∗∗Physics . 2007;69(5):1377–1380. doi: 10.1016/j.ijrobp.2007.05.005. PubMed DOI

Moore B. A., Weber R. S., Prieto V., et al. Lymph node metastases from cutaneous squamous cell carcinoma of the head and neck. The Laryngoscope . 2005;115(9):1561–1567. doi: 10.1097/01.mlg.0000173202.56739.9f. PubMed DOI

Dona E., Veness M. J., Cakir B., Morgan G. J. Metastatic cutaneous squamous cell carcinoma to the parotid: the role of surgery and adjuvant radiotherapy to achieve best outcome. Australia and New Zealand Journal of Surgery . 2003;73(9):692–696. doi: 10.1046/j.1445-2197.2003.02737.x. PubMed DOI

Audet N., Palme C. E., Gullane P. J., et al. Cutaneous metastatic squamous cell carcinoma to the parotid gland: analysis and outcome. Head and Neck . 2004;26(8):727–732. doi: 10.1002/hed.20048. PubMed DOI

Webber C., Gospodarowicz M., Sobin L. H. American Joint Committee on Cancer (AJCC). Cancer Staging Manual . New York, NY, USA: Springer; 2017.

Edafe O., Hughes B., Tsirevelou P., Goswamy J., Kumar R. Understanding primary parotid squamous cell carcinoma- A systematic review. The Surgeon . 2020;18(1):44–48. doi: 10.1016/j.surge.2019.03.006. PubMed DOI

Khurana V. G., Mentis D. H., O’Brien C. J., Hurst T. L., Stevens G. N., Packham N. A. Parotid and neck metastases from cutaneous squamous cell carcinoma of the head and neck. The American Journal of Surgery . 1995;170(5):446–450. doi: 10.1016/s0002-9610(99)80326-2. PubMed DOI

Pfisterer M. J., Vazquez A., Mady L. J., Khan M. N., Baredes S., Eloy J. A. Squamous cell carcinoma of the parotid gland: a population-based analysis of 2545 cases. American Journal of Otolaryngology . 2014;35(4):469–475. doi: 10.1016/j.amjoto.2014.03.003. PubMed DOI

Bron L. P., Traynor S. J., McNeil E. B., O’Brien C. J. Primary and metastatic cancer of the parotid: comparison of clinical behavior in 232 cases. The Laryngoscope . 2003;113(6):1070–1075. doi: 10.1097/00005537-200306000-00029. PubMed DOI

Taylor B. W., Jr, Brant T. A., Mendenhall N. P., et al. Carcinoma of the skin metastatic to parotid area lymph nodes. Head and Neck . 1991;13(5):427–433. doi: 10.1002/hed.2880130510. PubMed DOI

Marks M. W., Ryan R. F., Litwin M. S., Sonntag B. V. Squamous cell carcinoma of the parotid gland. Plastic and Reconstructive Surgery . 1987;79:550–554. doi: 10.1097/00006534-198704000-00006. PubMed DOI

Hong T. S., Kriesel K. J., Hartig G. K., Harari P. M. Parotid area lymph node metastases from cutaneous squamous cell carcinoma: implications for diagnosis, treatment, and prognosis. Head and Neck . 2005;27(10):851–856. doi: 10.1002/hed.20256. PubMed DOI

Goh R. Y., Bova R., Fogarty G. B. Cutaneous squamous cell carcinoma metastatic to parotid- analysis of prognostic factors and treatment outcome. World Journal of Surgical Oncology . 2012;10(1):p. 117. doi: 10.1186/1477-7819-10-117. PubMed DOI PMC

Taxy J. B. Squamous carcinoma in a major salivary gland: a review of the diagnostic considerations. Archives of Pathology and Laboratory Medicine . 2001;125(6):740–745. doi: 10.5858/2001-125-0740-SCIAMS. PubMed DOI

Maxwell J. H., Ferris R. L., Gooding W., et al. Extracapsular spread in head and neck carcinoma: impact of site and human papillomavirus status. Cancer . 2013;119(18):3302–3308. doi: 10.1002/cncr.28169. PubMed DOI

Yesensky J., Solis R. N., Bewley A. Facial nerve sacrifice during parotidectomy for metastatic cutaneous squamous cell carcinoma. Otolaryngology Open . 2021;5 doi: 10.1177/2473974X21996627. PubMed DOI PMC

Kampel L., Dorman A., Horovitz G., Warshavsky A., Gutfeld O., Muhanna N. The role of parotidectomy for advanced cutaneous squamous cell carcinoma of the head and neck. European Archives of Oto-Rhino-Laryngology . 2021;278(10):3955–3963. doi: 10.1007/s00405-020-06574-8. PubMed DOI

Wang L., Li H., Yang Z., Chen W., Zhang Q. Outcomes of primary squamous cell carcinoma of major salivary glands treated by surgery with or without postoperative radiotherapy. Journal of Oral and Maxillofacial Surgery . 2015;73(9):1860–1864. doi: 10.1016/j.joms.2015.03.016. PubMed DOI

Jackson G. L., Ballantyne A. J. Role of parotidectomy for skin cancer of the head and neck. The American Journal of Surgery . 1981;142(4):464–469. doi: 10.1016/0002-9610(81)90376-7. PubMed DOI

Harris B. N., Pipkorn P., Nguyen K. N. B., et al. Association of adjuvant radiation therapy with survival in patients with advanced cutaneous squamous cell carcinoma of the head and neck. Journal of the American Medical Association Otolaryngol Head Neck Surg . 2019;145(2):153–158. doi: 10.1001/jamaoto.2018.3650. PubMed DOI PMC

Haisma M. S., Plaat B. E. C., Bijl H. P., et al. Multivariate analysis of potential risk factors for lymph node metastasis in patients with cutaneous squamous cell carcinoma of the head and neck. Journal of the American Academy of Dermatology . 2016;75(4):722–730. doi: 10.1016/j.jaad.2016.06.010. PubMed DOI

Starek I., Salzman R., Skalova A., Chovanec M., Gál B., Zabrodsky M., et al. Guidelines for diagnosis and treatment of parotid gland tumours. Otorinolaryngologie a Foniatrie . 2017;66:120–125.

Olsen K. D., Moore E. J. Deep lobe parotidectomy: clinical rationale in the management of primary and metastatic cancer. European Archives of Oto-Rhino-Laryngology . 2014;271:1181–1185. doi: 10.1007/s00405-013-2616-8. PubMed DOI

Cracchiolo J. R., Shaha A. R. Parotidectomy for parotid cancer. Otolaryngologic Clinics of North America . 2016;49(2):415–424. doi: 10.1016/j.otc.2015.10.007. PubMed DOI PMC

Sweeny L., Zimmerman T., Carroll W. R., Schmalbach C. E., Day K. E., Rosenthal E. L. Head and neck cutaneous squamous cell carcinoma requiring parotidectomy: prognostic indicators and treatment selection. Otolaryngology- Head and Neck Surgery . 2014;150(4):610–617. doi: 10.1177/0194599814520686. PubMed DOI

Hirshoren N., Ruskin O., McDowell L. J., Magarey M., Kleid S., Dixon B. J. Management of parotid metastatic cutaneous squamous cell carcinoma: regional recurrence rates and survival. Otolaryngology- Head and Neck Surgery . 2018;159(2):293–299. doi: 10.1177/0194599818764348. PubMed DOI

Forest V. I., Clark J. J., Veness M. J., Milross C. N1S3: a revised staging system for head and neck cutaneous squamous cell carcinoma with lymph node metastases: results of 2 Australian cancer centers. Cancer . 2010;116(5):1298–1304. doi: 10.1002/cncr.24855. PubMed DOI

Vauterin T. J., Veness M. J., Morgan G. J., Poulsen M. G., O’Brien C. J. Patterns of lymph node spread of cutaneous squamous cell carcinoma of the head and neck. Head and Neck . 2006;28(9):785–791. doi: 10.1002/hed.20417. PubMed DOI

Ebrahimi A., Moncrieff M. D., Clark J. R., et al. Predicting the pattern of regional metastases from cutaneous squamous cell carcinoma of the head and neck based on location of the primary. Head and Neck . 2010;32(10):1288–1294. doi: 10.1002/hed.21332. PubMed DOI