Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. C URRENT O PINION Primary malignant parotid epithelial neoplasm: nodal metastases and management Patrick J. Bradley Purpose of review This article presents a summary of the recent publications on the diagnosis and management of primary malignant parotid epithelial neoplasm, with special emphasis on evaluation and treatment of nodal metastases. Recent findings Pathologists are challenged with making a diagnosis, classification and grading of salivary gland cancers. The unpredictable behaviour of this disease has been documented by clinicians reporting aggressiveness and variations in disease patterns within a single-cancer subgroup. Surgeons have identified a high incidence of occult nodal disease both at the primary site and the neck, which has frequently been understaged both clinically and on imaging in the presurgical workup. Summary The significance of a high incidence of occult nodal disease both at the primary site and the neck is that a more aggressive therapeutic strategy must be directed/advised by the multidisciplinary clinical team, to the disease located in the head and neck, thus improving likely cure, preventing local and distant disease failure. Keywords cervical nodal metastasis, intraglandular and extraglandular nodal metastasis, nodal metastasis, parotid cancer INTRODUCTION This review summarizes the published literature available on primary malignant parotid epithelial neoplasm and comments upon the epidemiology, evaluation, pathological diagnosis and grading, the diagnosis and management of occult and positive nodal disease. EPIDEMIOLOGY Salivary gland carcinomas have been reported as an incidence of 4–135 patients per million per year, with the highest reported rates being in Inuit Eskimos [1,2]. Primary salivary gland neoplasms are not all that uncommon, estimated at that 70–75 benign and 8–14 malignant neoplasms present annually per million population in a fixed population in the United Kingdom [3]. Approxi- mately, 70% of salivary carcinomas arise in the parotid gland [4–7] accounting for 1–5% of all head and neck carcinomas [8]. Data to evaluate the epidemiology and histopathology necessitate that data be collected over a prolonged period. Several of the reported studies have included a significant number of patients – some national [9,10] and some have been through a histological revision process [9,11–13]. Salivary gland neoplasms were classified (2005), and cover 24 histological subtypes with different potential and prognosis [8]. This classification was retrospectively applied to patients diagnosed with a primary salivary gland carcinoma from 1990 to 2005 among three Danish national registries [14]. Another study considered the variations in the epi- demiology of salivary gland tumours of epithelial origin reported on two distant geographical locations, Finland and Israel, and concluded when reporting on epidemiological studies based on the Department of Head and Neck Oncologic Surgery, Nottingham Univer- sity and Department of Otorhinolaryngology – Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, UK Correspondence to Professor Patrick J. Bradley, MBA, FRCS, 10 Chartwell Grove, Mapperley Plains, Nottingham NG3 5RD, UK. Tel: +00 44 115 9201611; e-mail: pjbradley@zoo.co.uk Curr Opin Otolaryngol Head Neck Surg 2015, 23:91–98 DOI:10.1097/MOO.0000000000000139 1068-9508 Copyright ß 2015 Wolters Kluwer Health, Inc. All rights reserved. www.co-otolaryngology.com REVIEW