Original Research—Head and Neck Surgery Management of Parotid Metastatic Cutaneous Squamous Cell Carcinoma: Regional Recurrence Rates and Survival Otolaryngology– Head and Neck Surgery 2018, Vol. 159(2) 293–299 Ó American Academy of Otolaryngology–Head and Neck Surgery Foundation 2018 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599818764348 http://otojournal.org Nir Hirshoren, MD 1 , Olivia Ruskin, MD 1 , Lachlan J. McDowell, MBBS, FRANZCR 2 , Matthew Magarey, MBBS, FRACS 1 , Stephen Kleid, MBBS, FRACS 1 , and Benjamin J. Dixon, MBBS, PhD, FRACS 1,3 No sponsorships or competing interests have been disclosed for this article. Abstract Objectives. Extent of parotidectomy and neck dissection for metastatic cutaneous squamous cell carcinoma (cSCC) to the parotid is debated. We describe our experience, analyz- ing outcomes (overall survival and regional recurrence) associated with surgical extent and adjuvant treatment. Study Design. A retrospective cohort study of parotidectomy with or without neck dissection for metastatic cSCC. Setting. A tertiary referral cancer center in Australia. Subjects and Methods. The study group consisted of patients with metastatic cSCC involving the parotid gland who underwent a curative-intent parotidectomy (superficial or total), with or with- out neck dissection, between 2003 and 2014. Demographic and clinical data, treatment modalities, and outcome parameters were collected from the electronic institutional database. Results. Of 78 patients, 65 underwent superficial parotidect- omy. Median follow-up was 6.5 years. Sixty-four patients (82%) patients received adjuvant radiotherapy. Cervical lymph nodes were involved in 6 (24%) elective neck dissec- tions. Involved preauricular, facial, external jugular, and occi- pital nodes occurred in 36.9%. Adjuvant radiotherapy was associated with improved 5-year survival—50% (95% CI, 36%-69%) versus 20% (95% CI, 6%-70%)—and improved 2- year regional control: 89% (95% CI, 67%-100%) versus 40% (95% CI, 14%-100%). The ipsilateral parotid bed recurrence rate was 3.7% for those who received adjuvant radiotherapy and 27% for those who did not receive radiotherapy. Conclusion. This study supports surgery plus adjuvant radiother- apy as a standard of care for metastatic cSCC. The low inci- dence of parotid bed recurrence with this approach suggests that routine elective deep lobe resection may not be required. Keywords parotidectomy, cutaneous squamous cell carcinoma, surgery, radiotherapy Received November 20, 2017; revised January 12, 2018; accepted February 20, 2018. M etastatic cutaneous cancer is the most common parotid malignancy in Australia. 1 The parotid bed is frequently involved in cutaneous squamous cell carcinoma (cSCC) arising from the face, ear, and frontotem- poral scalp. 2 The spread of head and neck cSCC to parotid lymph nodes has a significant negative prognostic impact, and some therefore suggest it should be incorporated into the current staging system. 1,3 Many consider superficial parotidectomy adequate surgi- cal management for metastatic cSCC not involving the deep lobe of the gland. Adjuvant radiotherapy with prophylactic coverage of the deep lobe appears to adequately treat subcli- nical micrometastases, and as such, it is the standard of care for these patients postoperatively. 4 Performing a total paroti- dectomy has not been proven to improve oncologic out- comes, and debate surrounds the risk of facial nerve injury without compromising regional control. 3,5 There is consen- sus that patients with metastatic cSCC who present with simultaneous cervical nodal disease undergo surgical man- agement of the neck as well as the parotid, followed by adjuvant radiotherapy to maximize regional control. 6 Agreement on optimal treatment of the clinically and radi- ologically negative neck, however, has not been reached, but many studies advocate for elective neck dissection, based on the high rates of microscopic disease found fol- lowing elective neck dissection. 2,4,7-9 Less is known about 1 Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia 2 Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia 3 Department of Surgery, University of Melbourne, St Vincent’s Hospital, Melbourne, Australia Corresponding Author: Nir Hirshoren, MD, Department of Surgical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne VIC 3000, Australia. Email: drnir@hadassah.org.il